MEDICARE: VIVAS COUNSELING SERVICES, 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	101YM0800X	Mental Health Counselor	MH12579	FL

General Provider Information

NPI Number	:	1861923815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVAS COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	6550 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-9031
Country	:	US
Telephone Number	:	772-932-8482
Fax Number	:	877-450-9298

Provider Business Practice Location Address
First Line	:	6550 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-9031
Country	:	US
Telephone Number	:	772-932-8482
Fax Number	:	877-450-9298

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. VALERIE CHRISTINE RICHARDS
Credential	:	LMHC, CST, EDS
Telephone Number	:	772-932-8482

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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