MEDICARE: COMPLETE COUNSELING GROUP, INC.

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	103T00000X	Psychologist	SW5538	FL
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710009873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE COUNSELING GROUP, INC.

Provider Business Mailing Address
First Line	:	333 NW 46TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-4010
Country	:	US
Telephone Number	:	954-732-5418
Fax Number	:	954-772-1023

Provider Business Practice Location Address
First Line	:	3115 NW 10TH TER STE 103
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5937
Country	:	US
Telephone Number	:	954-732-5418
Fax Number	:	954-772-1023

Authorized Official
Title or Position	:	PRESIDENT EXECUTIVE DIRECTOR
Name	:	MS. DEBRA J TANTILLO
Credential	:	LCSW
Telephone Number	:	954-732-5418

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	03/20/2025

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