Healthcare Provider Details

I. General information

NPI: 1194069864
Provider Name (Legal Business Name): CHILDRENS COUNSELING NETWORK, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SW PARK ST SUITE 203
OKEECHOBEE FL
34972-4173
US

IV. Provider business mailing address

605 SW PARK ST SUITE 203
OKEECHOBEE FL
34972-4173
US

V. Phone/Fax

Practice location:
  • Phone: 863-634-7226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9063
License Number StateFL

VIII. Authorized Official

Name: KELLIE CHAPMAN
Title or Position: COUNSELOR
Credential: LMHC
Phone: 863-634-7226