MEDICARE: BUILDING FOUNDATIONS COUNSELING, 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	101YM0800X	Mental Health Counselor	IMH13304	FL

General Provider Information

NPI Number	:	1962867242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING FOUNDATIONS COUNSELING, INC

Provider Business Mailing Address
First Line	:	202 LAKE MIRIAM DR STE W1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2179
Country	:	US
Telephone Number	:	863-614-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 LAKE MIRIAM DR STE W1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2179
Country	:	US
Telephone Number	:	863-614-5117
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JANET GHENT
Credential	:	MS
Telephone Number	:	863-614-5117

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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