MEDICARE: ABUNDANT LIFE COUNSELING SERVICES, PLLC

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	:	1427761501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2000 MALLORY LN STE 290
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6287
Country	:	US
Telephone Number	:	407-274-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 TUSKAWILLA RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5063
Country	:	US
Telephone Number	:	407-274-7067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE MADDEN
Credential	:
Telephone Number	:	407-274-7067

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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