MEDICARE: MULTICULTURAL COUNSELING CENTERS

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	101Y00000X	Counselor	MH2166	FL

General Provider Information

NPI Number	:	1609113141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTICULTURAL COUNSELING CENTERS

Provider Business Mailing Address
First Line	:	1850 LEE RD STE 300
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2107
Country	:	US
Telephone Number	:	407-740-8899
Fax Number	:	407-740-8771

Provider Business Practice Location Address
First Line	:	1850 LEE RD STE 300
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2107
Country	:	US
Telephone Number	:	407-740-8899
Fax Number	:	407-740-8771

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. CHARLES WESLEY ENLISH
Credential	:	PH. D.
Telephone Number	:	407-740-8899

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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