Healthcare Provider Details

I. General information

NPI: 1063358109
Provider Name (Legal Business Name): PREMIER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15742 MURCOTT HARVEST LOOP
WINTER GARDEN FL
34787-3246
US

IV. Provider business mailing address

8865 COMMODITY CIR STE 14-103
ORLANDO FL
32819-9056
US

V. Phone/Fax

Practice location:
  • Phone: 321-300-6723
  • Fax:
Mailing address:
  • Phone: 321-300-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SHIJU VARGHESE
Title or Position: MANAGER
Credential: LMFT
Phone: 973-229-3503