| |
2271 Park Ave Indian Lake Estates FL 33855 | |
(478) 919-7879 | |
Not Available |
Full Name | |
---|---|
Speciality | Counselor - Mental Health |
Location | 2271 Park Ave, Indian Lake Estates, Florida |
Authorized Official Name and Position | Rochely Terron (LPC, LMHC) |
Authorized Official Contact | 4789197879 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
815 N Homestead Blvd Ste 228 Homestead FL 33030-5024 Ph: (478) 783-4374 | 2271 Park Ave Indian Lake Estates FL 33855 Ph: (478) 919-7879 |
NPI Number | 1598206856 |
---|---|
Provider Enumeration Date | 03/20/2017 |
Last Update Date | 12/11/2024 |
Certification Date | 11/19/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598206856 | NPI | - | NPPES |
022169800 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | LPC008877 (Georgia) | Primary |