MEDICARE: ARCHER COUNSELING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1558977132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHER COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1635 E HIGHWAY 50 STE 204
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5035
Country	:	US
Telephone Number	:	352-708-5120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 E HIGHWAY 50 STE 204
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5035
Country	:	US
Telephone Number	:	352-708-5120
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	DR. DANIELLE ARCHER
Credential	:	ED.D., LMHC
Telephone Number	:	352-708-5120

Provider Enumeration Date	:	09/19/2020
Last Update Date	:	09/19/2020

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