Healthcare Provider Details

I. General information

NPI: 1346905916
Provider Name (Legal Business Name): GOOD SHEPHERD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E GRAVES AVE
ORANGE CITY FL
32763-5213
US

IV. Provider business mailing address

265 E GRAVES AVE
ORANGE CITY FL
32763-5213
US

V. Phone/Fax

Practice location:
  • Phone: 386-624-2177
  • Fax:
Mailing address:
  • Phone: 386-624-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ALLAN SPELLMAN
Title or Position: OWNER
Credential: LMHC, LMFT, NCC
Phone: 386-624-2177