MEDICARE: HOPE COUNSELING OF CENTRAL FL, 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	261QM0850X	Adult Mental Health Clinic/Center	MH 14082	FL

General Provider Information

NPI Number	:	1639621568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE COUNSELING OF CENTRAL FL, LLC

Provider Business Mailing Address
First Line	:	1905 MAGICAL LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5516
Country	:	US
Telephone Number	:	407-906-5214
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 RUBY AVE
Second Line	:	UNIT 213
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5627
Country	:	US
Telephone Number	:	407-906-5214
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LILLIANIS JALIERIS CRUZ
Credential	:	LMHC
Telephone Number	:	407-288-6417

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

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