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General NPI Number Information
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NPI Number | 1528362944
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Entity Type | Organization
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Legal Business Name | LIFE DISCOVERY COUNSELING CENTER
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 18371 EXCITING IDLEWILD BLVD
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City | LUTZ
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State | FL
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Zip | 33548
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Country | US
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Telephone | 813-264-8771
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Fax | 813-964-8943
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Provider Business Mailing Address
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Address Line | PO BOX 44
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City | LUTZ
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State | FL
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Zip | 33548
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Country | US
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Telephone | 813-264-8771
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Fax | 813-964-8943
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | JOANN EATON
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Credential |
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Telephone | 813-264-8771
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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 | MT2503
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH3707
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MT1854
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9814
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License Number State | FL
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