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General NPI Number Information
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NPI Number | 1619474251
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Entity Type | Organization
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Legal Business Name | A PATH TO CHANGE COUNSELING, LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 221 FRONTAGE ROAD SUITE A
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City | CLERMONT
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State | FL
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Zip | 32714
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Country | US
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Telephone | 352-356-5005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 691978
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City | ORLANDO
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State | FL
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Zip | 32869-1978
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Country | US
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Telephone | 352-356-5005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL EDWARD GILMAN
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Credential | MCAP, LMHC
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Telephone | 352-356-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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