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General NPI Number Information
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NPI Number | 1154137941
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Entity Type | Organization
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Legal Business Name | NEW AVENUE COUNSELING
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 3651 SE 136TH AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-1039
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Country | US
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Telephone | 901-609-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 MADISON AVE # 2835
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City | MEMPHIS
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State | TN
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Zip | 38104-2620
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Country | US
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Telephone | 901-609-5030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER KIERNAN
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Credential | LPC-MHSP
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Telephone | 901-609-5030
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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 |
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License Number State |
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