MEDICARE: GENESIS COUNSELING & CONSULTING, 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

General Provider Information

NPI Number	:	1972150647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS COUNSELING & CONSULTING, INC.

Provider Business Mailing Address
First Line	:	6971 N FEDERAL HWY STE 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1648
Country	:	US
Telephone Number	:	561-408-1098
Fax Number	:

Provider Business Practice Location Address
First Line	:	6971 N FEDERAL HWY STE 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1648
Country	:	US
Telephone Number	:	561-408-1098
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JENNIFER BISHOP
Credential	:	LMHC
Telephone Number	:	954-892-8603

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/18/2020

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