MEDICARE: HOPE COUNSELING CLINIC, 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	MH8080	FL

General Provider Information

NPI Number	:	1396193231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE COUNSELING CLINIC, LLC

Provider Business Mailing Address
First Line	:	410 N DILLARD ST STE 103
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-654-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N DILLARD ST STE 103
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-654-5700
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	JULIANA WOLF
Credential	:	LMHC
Telephone Number	:	407-654-5700

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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