MEDICARE: EPIPHANY 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1326511213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIPHANY COUNSELING, LLC

Provider Business Mailing Address
First Line	:	209 WAINSCOTT DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35757-7663
Country	:	US
Telephone Number	:	256-683-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 LIME QUARRY RD STE 212
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-8976
Country	:	US
Telephone Number	:	256-474-3400
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	JOANNE L. WEIS
Credential	:	LPC
Telephone Number	:	256-683-7333

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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