MEDICARE: COMPASSIONATE COUNSELING WITH KRISTEN, 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	101YM0800X	Mental Health Counselor	MH12704	FL

General Provider Information

NPI Number	:	1518322775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COUNSELING WITH KRISTEN, LLC

Provider Business Mailing Address
First Line	:	900 HILLSBORO MILE 2
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-2802
Country	:	US
Telephone Number	:	973-476-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 HILLSBORO MILE 2
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-2802
Country	:	US
Telephone Number	:	973-476-6371
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	KRISTEN J AGNELLO
Credential	:	LMHC, LPC,NCC, CCMHC
Telephone Number	:	973-476-6371

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	04/27/2017

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