MEDICARE: ENVISION COUNSELING SOLUTIONS, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1326657784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION COUNSELING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	10629 NW 12TH CT
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-6979
Country	:	US
Telephone Number	:	954-224-8550
Fax Number	:

Provider Business Practice Location Address
First Line	:	8360 W OAKLAND PARK BLVD # 210J
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-7332
Country	:	US
Telephone Number	:	954-224-8550
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	ANIKA BOWEN
Credential	:	LMHC
Telephone Number	:	954-224-8550

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	05/17/2022

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