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General NPI Number Information
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NPI Number | 1659806313
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER OF BREVARD, LLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 1413 S PATRICK DR SUITE 1
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4373
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Country | US
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Telephone | 321-432-9282
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Fax | 321-777-5964
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Provider Business Mailing Address
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Address Line | 1413 S. PATRICK DR. SUITE 1
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937
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Country | US
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Telephone | 321-432-9282
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Fax | 321-777-5964
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Authorized Official
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Title or Position | LMHC
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Name | MRS. KARIN PAINTER
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Credential | MS
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Telephone | 321-543-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MH 13192
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License Number State | FL
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