MEDICARE: CONNECT 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	:	1831974633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT COUNSELING & CONSULTING LLC

Provider Business Mailing Address
First Line	:	402 OFFICE PARK DR STE 250
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 OFFICE PARK DR
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-202-1143
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST AND OWNER
Name	:	DEBORAH SHUNNARAH
Credential	:	ALC, NCC
Telephone Number	:	205-202-1143

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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