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General NPI Number Information
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NPI Number | 1619493970
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Entity Type | Organization
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Legal Business Name | COOPERATIVE COACHING CONCEPTS
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 3607 ALT 19 STE B
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City | PALM HARBOR
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State | FL
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Zip | 34683-1412
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Country | US
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Telephone | 727-505-2155
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Fax | 727-796-0158
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Provider Business Mailing Address
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Address Line | 686 ROANOKE ST
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City | DUNEDIN
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State | FL
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Zip | 34698-8421
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Country | US
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Telephone | 727-505-2155
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Fax | 727-796-0158
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW HOWE WELCH
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Credential | LMFT
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Telephone | 727-505-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2587
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License Number State | FL
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