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General NPI Number Information
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NPI Number | 1912439274
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Entity Type | Organization
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Legal Business Name | CASA FELIZ COUNSELING LLC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2425 S VOLUSIA AVE STE B4
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City | ORANGE CITY
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State | FL
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Zip | 32763-7625
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Country | US
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Telephone | 321-578-7488
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 S VOLUSIA AVE STE B4
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City | ORANGE CITY
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State | FL
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Zip | 32763-7625
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Country | US
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Telephone | 321-578-7488
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Fax | 877-540-1113
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Authorized Official
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Title or Position | CEO/OWNER
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Name | GRACIELA PULLIAM
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Credential | LMHC
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Telephone | 321-578-7488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9913
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License Number State | FL
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