=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487290086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORION COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2019
-----------------------------------------------------
Last Update Date | 11/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 PALM TRL STE 200
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-271-3452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 SW 13TH AVE
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-5964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-271-3452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MARCEL A FORT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 561-271-3452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------