| Sunrise Counseling Services, Pllc | |
|
297 E Highway 50 Ste 1 Clermont FL 34711-2500 | |
| (407) 205-5589 | |
| Not Available |
| Full Name | Sunrise Counseling Services, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 297 E Highway 50 Ste 1, Clermont, Florida |
| Authorized Official Name and Position | Roberto Gouthman (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7868435463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Counseling Services, Pllc 6939 Green Swamp Rd Clermont FL 34714-9729 Ph: (140) 720-5558 | Sunrise Counseling Services, Pllc 297 E Highway 50 Ste 1 Clermont FL 34711-2500 Ph: (407) 205-5589 |
| NPI Number | 1710624101 |
|---|---|
| Provider Enumeration Date | 05/17/2022 |
| Last Update Date | 06/27/2024 |
| Certification Date | 06/27/2024 |
| Medicare PECOS PAC ID | 4385181759 |
|---|---|
| Medicare Enrollment ID | O20240802001254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710624101 | NPI | - | NPPES |
| 1019414110002 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Roberto Gouthman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437688702 PECOS PAC ID: 8022419449 Enrollment ID: I20210623001143 |
| Provider Name | Johari Patrice Faison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386399095 PECOS PAC ID: 9133516826 Enrollment ID: I20220427002713 |
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