MEDICARE: ANCHORAGE COUNSELING SERVICE, 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	251S00000X	Community/Behavioral Health Agency	MH1369	FL

General Provider Information

NPI Number	:	1295009413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHORAGE COUNSELING SERVICE, INC

Provider Business Mailing Address
First Line	:	178 KEVIN DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4378
Country	:	US
Telephone Number	:	850-291-9293
Fax Number	:	850-607-6935

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD STE 11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-433-2042
Fax Number	:	850-607-6935

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. LORRAINE MILLELOT GRAVES
Credential	:	LMCH
Telephone Number	:	850-433-2042

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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