MEDICARE: NEW HEIGHTS COUNSELING & CONSULTING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679142897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HEIGHTS COUNSELING & CONSULTING LLC

Provider Business Mailing Address
First Line	:	1425 HICKORY AVE
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-3222
Country	:	US
Telephone Number	:	850-757-1552
Fax Number	:	850-757-1703

Provider Business Practice Location Address
First Line	:	1992 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:	850-757-1552
Fax Number	:	850-757-1703

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. COLLEEN LYNN WENNER-FOY
Credential	:	LMHC-S
Telephone Number	:	850-757-1552

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	07/09/2021

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