| Southwest Florida Sports Counseling Llc | |
|
621 Cape Coral Pkwy E Ste 19c Cape Coral FL 33904-8548 | |
| (941) 677-8002 | |
| Not Available |
| Full Name | Southwest Florida Sports Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 621 Cape Coral Pkwy E Ste 19c, Cape Coral, Florida |
| Authorized Official Name and Position | Kimberly A Rogers (OWNER) |
| Authorized Official Contact | 9416778002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Florida Sports Counseling Llc 621 Cape Coral Pkwy E Ste 19c Cape Coral FL 33904-8548 Ph: (941) 677-8002 | Southwest Florida Sports Counseling Llc 621 Cape Coral Pkwy E Ste 19c Cape Coral FL 33904-8548 Ph: (941) 677-8002 |
| NPI Number | 1457002164 |
|---|---|
| Provider Enumeration Date | 01/13/2022 |
| Last Update Date | 01/13/2022 |
| Certification Date | 01/13/2022 |
| Medicare PECOS PAC ID | 7517319197 |
|---|---|
| Medicare Enrollment ID | O20240118004456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457002164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kimberly A Rogers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477855476 PECOS PAC ID: 0244682821 Enrollment ID: I20240118004490 |
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