Greater Good Life Services Llc | |
2033 E Edgewood Dr Suite 4 Lakeland FL 33803-3660 | |
(863) 271-7972 | |
Not Available |
Full Name | Greater Good Life Services Llc |
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Speciality | Counselor |
Location | 2033 E Edgewood Dr, Lakeland, Florida |
Authorized Official Name and Position | Heather Stambaugh (OWNER) |
Authorized Official Contact | 8632717972 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Greater Good Life Services Llc 2033 E Edgewood Dr Suite 4 Lakeland FL 33803-3660 Ph: (863) 271-7972 | Greater Good Life Services Llc 2033 E Edgewood Dr Suite 4 Lakeland FL 33803-3660 Ph: (863) 271-7972 |
NPI Number | 1245770221 |
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Provider Enumeration Date | 02/24/2017 |
Last Update Date | 02/24/2017 |
Medicare PECOS PAC ID | 4688023971 |
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Medicare Enrollment ID | O20231212002740 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245770221 | NPI | - | NPPES |
007986200 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
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101YM0800X | Counselor - Mental Health | MH11554 (Florida) | Primary |
Provider Name | Heather Stambaugh |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1912221953 PECOS PAC ID: 1355799537 Enrollment ID: I20231128003904 |
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