MEDICARE: LIVING STONES BEHAVIORAL HEALTH 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	251B00000X	Case Management Agency
2	101Y00000X	Counselor	12345	FL
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	12345	FL
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist	12345	FL
5	251S00000X	Community/Behavioral Health Agency		FL

General Provider Information

NPI Number	:	1841654639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING STONES BEHAVIORAL HEALTH INC.

Provider Business Mailing Address
First Line	:	940 W OAKLAND AVE
Second Line	:	SUITE A9
City	:	OAKLAND
State	:	FL
Zip	:	34787-1802
Country	:	US
Telephone Number	:	407-446-9814
Fax Number	:	407-540-9683

Provider Business Practice Location Address
First Line	:	940 W OAKLAND AVE
Second Line	:	SUITE A9
City	:	OAKLAND
State	:	FL
Zip	:	34787-1802
Country	:	US
Telephone Number	:	407-446-9814
Fax Number	:	407-540-9683

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERSKIN BELL
Credential	:
Telephone Number	:	407-446-9814

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	05/25/2016

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