MEDICARE: DEFIB CLINICAL 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1285415901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFIB CLINICAL COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1020 MONTICELLO CT STE 200
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1968
Country	:	US
Telephone Number	:	334-440-6217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 MONTICELLO CT STE 200
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1968
Country	:	US
Telephone Number	:	334-440-6217
Fax Number	:

Authorized Official
Title or Position	:	CEO/INTEGRATIVE CLINICAL COUNSELOR
Name	:	MR. JERROD CRITTENDEN
Credential	:	ALC
Telephone Number	:	334-440-6217

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	02/25/2026

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