MEDICARE: THERAPY FOR LIVING, 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	101YM0800X	Mental Health Counselor	MH11799	FL

General Provider Information

NPI Number	:	1497129639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY FOR LIVING, INC

Provider Business Mailing Address
First Line	:	1544 RUSKIN LN
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1958
Country	:	US
Telephone Number	:	904-405-9469
Fax Number	:	855-261-3372

Provider Business Practice Location Address
First Line	:	1544 RUSKIN LN
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1958
Country	:	US
Telephone Number	:	904-405-9469
Fax Number	:	855-261-3372

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LORI BEARD
Credential	:	LMHC
Telephone Number	:	904-405-9469

Provider Enumeration Date	:	11/28/2015
Last Update Date	:	11/28/2015

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