Organization
GENESIS COUNSELING CENTER
Active
Organization
GENESIS COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN MARTIN LMHC (LICENSED MENTAL HEALTH COUNSELOR)
(239) 849-6813
Entity
Organization
Contact information
Practice address
8359 BEACON BLVD STE 200, FORT MYERS, FL 33907-3065
(239) 849-6813
Mailing address
8359 BEACON BLVD STE 200, FORT MYERS, FL 33907-3065
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
12248
FL
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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