MEDICARE: CENTER FOR SEXUAL HEALTH & WELLNESS, 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	101Y00000X	Counselor	MH12547	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP10044	FL
3	101YP2500X	Professional Counselor	MH12547	FL
4	101YM0800X	Mental Health Counselor	MH12547	FL

General Provider Information

NPI Number	:	1841722741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SEXUAL HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1860 SW FOUNTAINVIEW BLVD STE 100
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-4528
Country	:	US
Telephone Number	:	772-208-7834
Fax Number	:	495-774-6179

Provider Business Practice Location Address
First Line	:	1860 SW FOUNTAINVIEW BLVD STE 100
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-4528
Country	:	US
Telephone Number	:	772-208-7834
Fax Number	:	495-774-6179

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. CHASITY SHANELL CHANDLER
Credential	:	LMHC, MCAP, ICADC,
Telephone Number	:	772-245-7608

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	10/29/2021

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Directions to “CENTER FOR SEXUAL HEALTH & WELLNESS, LLC ” Practice Location

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