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General NPI Number Information
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NPI Number | 1013461318
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Entity Type | Organization
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Legal Business Name | MASTERS COUNSELING SERVICES
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 4055 TAMIAMI TRL SUITE 20
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9212
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Country | US
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Telephone | 941-456-9151
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Fax | 941-456-7181
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Provider Business Mailing Address
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Address Line | PO BOX 494708
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-4708
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Country | US
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Telephone | 941-456-9151
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Fax | 941-456-7181
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Authorized Official
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Title or Position | SOLE PRACTITIONER
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Name | MS. PATRICIA MCCOY MASTERS
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Credential | MSW
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Telephone | 941-456-9151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW191
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License Number State | FL
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