MEDICARE: EKILIBRIUM, INC.

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225608557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EKILIBRIUM, INC.

Provider Business Mailing Address
First Line	:	667 ERROL PKWY
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-2625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 E JEFFERSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6116
Country	:	US
Telephone Number	:	305-440-8920
Fax Number	:	786-431-2573

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLADYS AROCHE
Credential	:	LMHC-S
Telephone Number	:	305-440-8920

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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Directions to “EKILIBRIUM, INC. ” Practice Location

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