MEDICARE: COUNSELING AND RECOVERY CENTER, 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	261Q00000X	Clinic/Center	1556AD805100	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447345574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING AND RECOVERY CENTER, INC.

Provider Business Mailing Address
First Line	:	4753 ORANGE AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-3410
Country	:	US
Telephone Number	:	772-467-3057
Fax Number	:	772-467-3059

Provider Business Practice Location Address
First Line	:	4753 ORANGE AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-3410
Country	:	US
Telephone Number	:	772-467-3057
Fax Number	:	772-467-3059

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JILL MARIE ARNOLD
Credential	:	LMHC
Telephone Number	:	772-467-3057

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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