MEDICARE: FAMILY FIRST COUNSELING SERVICES

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	251S00000X	Community/Behavioral Health Agency	MH7753	FL

General Provider Information

NPI Number	:	1669732004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	1338 PORT MALABAR BLVD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-5259
Country	:	US
Telephone Number	:	321-720-1709
Fax Number	:	321-733-1860

Provider Business Practice Location Address
First Line	:	2194 HWY A1A STE 203
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4931
Country	:	US
Telephone Number	:	321-720-1708
Fax Number	:	321-773-5497

Authorized Official
Title or Position	:	CEO
Name	:	MS. RAHILA A BASHIR
Credential	:	LMHC
Telephone Number	:	321-720-1709

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	05/18/2012

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Directions to “FAMILY FIRST COUNSELING SERVICES ” Practice Location

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