Healthcare Provider Details

I. General information

NPI: 1265072532
Provider Name (Legal Business Name): TREE OF LIFE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

IV. Provider business mailing address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

V. Phone/Fax

Practice location:
  • Phone: 850-449-0589
  • Fax: 850-396-6019
Mailing address:
  • Phone: 850-449-0589
  • Fax: 850-396-6019

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DESROCHERS
Title or Position: OWNER
Credential:
Phone: 850-449-0589