Healthcare Provider Details

I. General information

NPI: 1033560347
Provider Name (Legal Business Name): BETTER LIFE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ALICIA RD
LAKELAND FL
33801-2104
US

IV. Provider business mailing address

930 ALICIA RD
LAKELAND FL
33801-2104
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax: 863-683-4654
Mailing address:
  • Phone: 863-680-1950
  • Fax: 863-683-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6758
License Number StateFL

VIII. Authorized Official

Name: VIVIAN M MEHNERT
Title or Position: OWNER
Credential: MA
Phone: 863-604-2535