=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568653160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPANDING HORIZONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2007
-----------------------------------------------------
Last Update Date | 08/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3419 CYPRESS POINT CIR
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34772-8615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-301-3791
-----------------------------------------------------
Fax | 407-902-0019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 816 PENNSYLVANIA AVE
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-3371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-301-3791
-----------------------------------------------------
Fax | 407-902-0019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY DIRECTOR
-----------------------------------------------------
Name | MS. ALMA TERESA BIRD
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 407-301-3791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------