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General NPI Number Information
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NPI Number | 1982043840
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Entity Type | Organization
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Legal Business Name | HEALING COUNSELING
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 10400 SW STEPHANIE WAY APT 207
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1974
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Country | US
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Telephone | 813-416-5458
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Fax | 772-237-7726
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Provider Business Mailing Address
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Address Line | 10400 SW STEPHANIE WAY APT 207
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1974
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Country | US
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Telephone | 813-416-5458
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Fax | 772-237-7726
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Authorized Official
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Title or Position | LICENSE THERAPIST
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Name | MR. ROBERT MEDINA
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Credential | LMHC/CAP
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Telephone | 813-416-5458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH9670
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License Number State | FL
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