| Space Coast Counseling Center, Inc. | |
|
166 Center St Ste 239 Cape Canaveral FL 32920-3717 | |
| (321) 267-2288 | |
| (866) 703-0035 |
| Full Name | Space Coast Counseling Center, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 166 Center St Ste 239, Cape Canaveral, Florida |
| Authorized Official Name and Position | Lana Lynn Beasley (PRESIDENT) |
| Authorized Official Contact | 3212672228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Space Coast Counseling Center, Inc. Po Box 1284 Cape Canaveral FL 32920-1284 Ph: (321) 267-2288 | Space Coast Counseling Center, Inc. 166 Center St Ste 239 Cape Canaveral FL 32920-3717 Ph: (321) 267-2288 |
| NPI Number | 1316070345 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 06/17/2022 |
| Certification Date | 06/17/2022 |
| Medicare PECOS PAC ID | 2567811375 |
|---|---|
| Medicare Enrollment ID | O20231205003150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316070345 | NPI | - | NPPES |
| 00493900 | Medicaid | FL | |
| 113658100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Lana Lynn Beasley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275675688 PECOS PAC ID: 3476902289 Enrollment ID: I20231205003270 |
Fox Professional Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 166 Center St Ste 203a, Cape Canaveral, FL 32920 Phone: 321-432-6080 |