MEDICARE: KLA 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	251S00000X	Community/Behavioral Health Agency	MH 9214	FL

General Provider Information

NPI Number	:	1962790121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLA COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	4653 SW BERMUDA WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-1220
Country	:	US
Telephone Number	:	772-233-4282
Fax Number	:	772-248-1358

Provider Business Practice Location Address
First Line	:	850 NW FEDERAL HWY
Second Line	:	SUITE 111
City	:	STUART
State	:	FL
Zip	:	34994-1019
Country	:	US
Telephone Number	:	772-233-4282
Fax Number	:	772-248-1358

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLIE PARRIS AGULIA
Credential	:	MS, LMHC
Telephone Number	:	772-233-4282

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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