MEDICARE: PHASE OF LIFE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154194983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASE OF LIFE COUNSELING LLC

Provider Business Mailing Address
First Line	:	3204 BAYFLOWER AVE
Second Line	:
City	:	HARMONY
State	:	FL
Zip	:	34773-6080
Country	:	US
Telephone Number	:	917-595-0248
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N BEAUMONT AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5120
Country	:	US
Telephone Number	:	917-595-0248
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA EDMUND
Credential	:	LMHC
Telephone Number	:	917-595-0248

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	12/04/2023

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