=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669706891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A BETTER LIFE COUNSELING SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 05/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1155 S SEMORAN BLVD STE 1150
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-5505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-6059
-----------------------------------------------------
Fax | 407-374-1771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1195
-----------------------------------------------------
City | GOLDENROD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32733-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-6059
-----------------------------------------------------
Fax | 407-977-8639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MARGOT LOGAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 407-739-6059
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW7259
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------