MEDICARE: KNOWLEDGE EMPOWERS YOU COUNSELING SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	102X00000X	Poetry Therapist
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker
5	106H00000X	Marriage & Family Therapist
6	106S00000X	Behavior Technician
7	251S00000X	Community/Behavioral Health Agency
8	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740758275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOWLEDGE EMPOWERS YOU COUNSELING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2595 SANFORD AVE
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32773-4606
Country	:	US
Telephone Number	:	407-906-0139
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1026
Country	:	US
Telephone Number	:	407-906-0139
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. PERNELL M.J. BUSH
Credential	:	MSW, CNP
Telephone Number	:	407-792-9591

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	08/29/2022

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