MEDICARE: ENLIGHTENMENT COUNSELING CENTER, 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	:	1619576469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHTENMENT COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	1101 E CUMBERLAND AVE # 201H-132
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4231
Country	:	US
Telephone Number	:	754-300-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 E CUMBERLAND AVE # 201H-132
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4231
Country	:	US
Telephone Number	:	754-300-8107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETSY RODRIGUEZ
Credential	:	LMHC
Telephone Number	:	754-300-8107

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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