MEDICARE: BREVARD 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1245119916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVARD COUNSELING, LLC

Provider Business Mailing Address
First Line	:	709 ALABAMA AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2641
Country	:	US
Telephone Number	:	256-273-7012
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 ALABAMA AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2641
Country	:	US
Telephone Number	:	256-273-7012
Fax Number	:

Authorized Official
Title or Position	:	CEO/THERAPIST
Name	:	CATHERINE WILBANKS
Credential	:	LPC
Telephone Number	:	256-273-7012

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “BREVARD COUNSELING, LLC ” Practice Location

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