MEDICARE: AP FAMILY LIFE EDUCATIONAL COUNSELING & CONSULTING SVS 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	101Y00000X	Counselor	MH8956	FL
2	101YM0800X	Mental Health Counselor	MH8956	FL
3	102L00000X	Psychoanalyst	MH8956	FL
4	103K00000X	Behavior Analyst	MH8956	FL
5	103T00000X	Psychologist	MH8956	FL
6	251S00000X	Community/Behavioral Health Agency	MH8956	FL

General Provider Information

NPI Number	:	1477856995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AP FAMILY LIFE EDUCATIONAL COUNSELING & CONSULTING SVS INC

Provider Business Mailing Address
First Line	:	PO BOX 977
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402-0977
Country	:	US
Telephone Number	:	850-763-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 MIRACLE STRIP LOOP STE 14
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-8410
Country	:	US
Telephone Number	:	850-763-8100
Fax Number	:	850-763-0707

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. ANITA PEMBLETON
Credential	:	PHD
Telephone Number	:	850-763-8100

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	06/09/2020

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