MEDICARE: LIFE ADVENTURES COUNSELING & CONSULTING, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1184241085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ADVENTURES COUNSELING & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	8588 STARKEY RD STE E
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	727-481-4577
Fax Number	:	727-498-5698

Provider Business Practice Location Address
First Line	:	8588 STARKEY RD STE E
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	727-481-4577
Fax Number	:	727-498-5698

Authorized Official
Title or Position	:	CEO
Name	:	DANA MAUREEN LUNG
Credential	:	PHD
Telephone Number	:	727-481-4577

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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