MEDICARE: ATLANTIC COUNSELING SERVICES, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1932471620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	200 KNUTH RD
Second Line	:	SUITE 238
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	561-734-6100
Fax Number	:	561-969-9067

Provider Business Practice Location Address
First Line	:	200 KNUTH RD
Second Line	:	SUITE 238
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	561-734-6100
Fax Number	:	561-969-9067

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ESSIE TARR
Credential	:	ARNP MS BC CHT
Telephone Number	:	561-734-6100

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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