MEDICARE: WHOLE AGAIN THERAPY 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

General Provider Information

NPI Number	:	1548901903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE AGAIN THERAPY LLC

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD STE 201-K
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3204
Country	:	US
Telephone Number	:	561-501-0955
Fax Number	:	561-484-7078

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD STE 201-K
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3204
Country	:	US
Telephone Number	:	561-501-0955
Fax Number	:	561-484-7078

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. CAROLYN M ROSE
Credential	:	LMHC, NCC
Telephone Number	:	561-501-0955

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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