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General NPI Number Information
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NPI Number | 1164880548
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Entity Type | Organization
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Legal Business Name | ENDURING PEACE COUNSELING LLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 5110 S FLORIDA AVE STE 114
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City | LAKELAND
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State | FL
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Zip | 33813-2517
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Country | US
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Telephone | 863-738-8538
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Fax | 863-510-5903
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Provider Business Mailing Address
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Address Line | 5110 S FLORIDA AVE STE 114
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City | LAKELAND
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State | FL
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Zip | 33813-2517
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Country | US
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Telephone | 863-738-8538
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Fax | 863-510-5903
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Authorized Official
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Title or Position | OWNER
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Name | BEVERLY C. ROUSSEAU
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Credential | LMHC
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Telephone | 863-738-8538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH13024
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License Number State | FL
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