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Organization
SPACE COAST COUNSELING CENTER, INC.
Active
Organization
SPACE COAST COUNSELING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LANA LYNN BEASLEY MA, LMHC (PRESIDENT)
(321) 267-2228
Entity
Organization
Contact information
Practice address
166 CENTER ST STE 239, CAPE CANAVERAL, FL 32920-3717
(321) 267-2288
(866) 703-0035
Mailing address
PO BOX 1284, CAPE CANAVERAL, FL 32920-1284
(321) 267-2288
(866) 703-0035
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00493900
—
FL
05
—
113658100
—
FL
Enumeration date
03/13/2007
Last updated
06/17/2022
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