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General NPI Number Information
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NPI Number | 1811352131
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Entity Type | Organization
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Legal Business Name | COFFEE COUNSELING, COACHING, & CONSULTING
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 2180 N PARK AVE STE 220
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City | WINTER PARK
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State | FL
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Zip | 32789-2358
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Country | US
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Telephone | 407-644-4911
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Fax | 407-644-4911
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Provider Business Mailing Address
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Address Line | 350 FITZHUGH RD
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City | WINTER PARK
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State | FL
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Zip | 32792-3537
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Country | US
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Telephone | 407-644-4911
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Fax | 407-644-4911
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | BARBARA MAGNUSSON COFFEE
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Credential | LMFT, PH.D., ABD
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Telephone | 407-644-4911
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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 | MT1916
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License Number State | FL
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