Healthcare Provider Details

I. General information

NPI: 1730963208
Provider Name (Legal Business Name): ETC COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 AVENUE O SW
MOORE HAVEN FL
33471-2010
US

IV. Provider business mailing address

615 AVENUE O SW
MOORE HAVEN FL
33471-2010
US

V. Phone/Fax

Practice location:
  • Phone: 863-265-0665
  • Fax: 863-946-1257
Mailing address:
  • Phone: 863-265-0665
  • Fax: 863-946-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD WALTER CLEWELL
Title or Position: OWNER
Credential: LCSW
Phone: 863-265-0665