MEDICARE: GENTLE PACE 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467396499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE PACE COUNSELING LLC

Provider Business Mailing Address
First Line	:	1860 SW FOUNTAINVIEW BLVD STE 100
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4528
Country	:	US
Telephone Number	:	772-332-9699
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 SW FOUNTAINVIEW BLVD STE 100
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4528
Country	:	US
Telephone Number	:	772-332-9699
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KIMBERLY T ELLIS
Credential	:	LCSW
Telephone Number	:	845-798-2002

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	06/09/2026

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