MEDICARE: ABOVE AND BEYOND COUNSELING SERVICES OF FLORIDA, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841509544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE AND BEYOND COUNSELING SERVICES OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	4680 LIPSCOMB ST NE
Second Line	:	SUITES 10C AND 10D
City	:	PALM BAY
State	:	FL
Zip	:	32905-2984
Country	:	US
Telephone Number	:	973-239-0948
Fax Number	:	973-239-0972

Provider Business Practice Location Address
First Line	:	4680 LIPSCOMB ST NE
Second Line	:	SUITES 10C AND 10D
City	:	PALM BAY
State	:	FL
Zip	:	32905-2984
Country	:	US
Telephone Number	:	973-239-0948
Fax Number	:	973-239-0972

Authorized Official
Title or Position	:	OWNER
Name	:	MISS WYNANTE SEWELL
Credential	:	LPC
Telephone Number	:	732-987-3946

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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