=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104655463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRIVE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2024
-----------------------------------------------------
Last Update Date | 07/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 A1A S STE A
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-5582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-990-4524
-----------------------------------------------------
Fax | 904-770-3818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 A1A S STE A
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-5582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-990-4524
-----------------------------------------------------
Fax | 904-770-3818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED THERAPIST
-----------------------------------------------------
Name | MS. LINDSAY FABER
-----------------------------------------------------
Credential | LMHC, LMFT, QS
-----------------------------------------------------
Telephone | 904-990-4524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------