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General NPI Number Information
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NPI Number | 1427554625
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Entity Type | Organization
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Legal Business Name | EMERALD SHORES COUNSELING LLC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 4300 BAYOU BLVD STE 21
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City | PENSACOLA
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State | FL
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Zip | 32503-2671
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Country | US
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Telephone | 850-816-6510
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Fax | 850-361-3220
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Provider Business Mailing Address
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Address Line | 4300 BAYOU BLVD STE 21
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City | PENSACOLA
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State | FL
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Zip | 32503-2671
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Country | US
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Telephone | 850-816-6510
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Fax | 850-361-3220
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JOSEPH BOARTS
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Credential | LMHC
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Telephone | 850-816-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MH14563
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License Number State | FL
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