Healthcare Provider Details

I. General information

NPI: 1396200440
Provider Name (Legal Business Name): OCEANSIDE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SW FEDERAL HWY STE 200G
STUART FL
34994-2972
US

IV. Provider business mailing address

759 SW FEDERAL HWY STE 200B
STUART FL
34994-2972
US

V. Phone/Fax

Practice location:
  • Phone: 561-358-5081
  • Fax:
Mailing address:
  • Phone: 561-358-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENA GARROW
Title or Position: OWNER
Credential:
Phone: 561-358-5081