=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740627959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY HARBOR COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2013
-----------------------------------------------------
Last Update Date | 05/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2014 4TH ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-925-8570
-----------------------------------------------------
Fax | 941-925-8574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2014 4TH ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-925-8570
-----------------------------------------------------
Fax | 941-925-8574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. STACY A LOUK
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 941-925-8570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH9651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------