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General NPI Number Information
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NPI Number | 1174906309
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Entity Type | Organization
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Legal Business Name | BAYLIFE COUNSELING, LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 6611 US HIGHWAY 19 SUITE 203
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1732
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Country | US
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Telephone | 727-741-0704
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Fax | 888-972-7961
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Provider Business Mailing Address
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Address Line | 6611 US HIGHWAY 19 SUITE 203
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1732
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Country | US
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Telephone | 727-741-0704
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Fax | 888-972-7961
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KEVIN M STEVENSON
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Credential | LMHC, CAP
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Telephone | 727-741-0704
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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 | MH7098
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License Number State | FL
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