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Organization
LIFESTYLE COUNSELING
Active
Organization
LIFESTYLE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE HARRISON (PRESIDENT)
(850) 712-3779
Entity
Organization
Contact information
Practice address
203 CLOVERDALE BLVD, FORT WALTON BEACH, FL 32547-1405
(850) 712-3779
Mailing address
70 6TH ST, SHALIMAR, FL 32579-1362
(850) 712-3779
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
12824
FL
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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