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General NPI Number Information
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NPI Number | 1023396934
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Entity Type | Organization
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Legal Business Name | TREVON CLOW COUNSELING THERAPIES, INC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 221 N CAUSEWAY SUITE B
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5298
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Country | US
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Telephone | 386-428-4564
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Fax | 386-428-4539
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Provider Business Mailing Address
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Address Line | 221 N CAUSEWAY SUITE B
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5298
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Country | US
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Telephone | 386-428-4564
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Fax | 386-428-4539
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DEANNE LYNN DEPEW
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Credential |
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Telephone | 386-428-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH5611
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License Number State | FL
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