MEDICARE: HEALOGY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578151155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGY COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	15017 N DALE MABRY HWY # 1048
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15017 N DALE MABRY HWY # 1048
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1816
Country	:	US
Telephone Number	:	407-349-7103
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDN HABTE
Credential	:
Telephone Number	:	267-408-5049

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	11/02/2021

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