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General NPI Number Information
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NPI Number | 1073029252
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/25/2017
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Last Update Date | 12/25/2017
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Provider Practice Location Address
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Address Line | 7151 MAILLER ST
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City | ORLANDO
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State | FL
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Zip | 32818-8861
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Country | US
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Telephone | 407-716-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 7151 MAILLER ST
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City | ORLANDO
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State | FL
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Zip | 32818-8861
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Country | US
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Telephone | 407-716-7668
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | BARBARA JO FULLER
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Credential | LMHC
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Telephone | 407-716-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | L13000079124
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License Number State | FL
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