MEDICARE: EPIPHANY COUNSELING AND PROFESSIONAL SERVICES, 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
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1538760244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIPHANY COUNSELING AND PROFESSIONAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	7971 RIVIERA BLVD STE 112
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7971 RIVIERA BLVD STE 112
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6453
Country	:	US
Telephone Number	:	954-744-4369
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. EBONY STURRUP
Credential	:	LMFT, LMHC
Telephone Number	:	954-254-9982

Provider Enumeration Date	:	11/08/2020
Last Update Date	:	05/29/2026

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