MEDICARE: VICTORY COUNSELING AND THERAPY 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1710572896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY COUNSELING AND THERAPY LLC

Provider Business Mailing Address
First Line	:	2029 OKEECHOBEE BLVD # 1027
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4131
Country	:	US
Telephone Number	:	561-206-2132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2029 OKEECHOBEE BLVD # 1027
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4131
Country	:	US
Telephone Number	:	561-206-2132
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	MR. PERRY HUFF JR.
Credential	:	LICSW, LCSW
Telephone Number	:	561-206-2132

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	09/15/2021

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