Provider Demographics
NPI:1003392531
Name:SEASONS OF LIFE COUNSELING, LLC
Entity Type:Organization
Organization Name:SEASONS OF LIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, LCCT
Authorized Official - Phone:850-201-7177
Mailing Address - Street 1:113 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1529
Mailing Address - Country:US
Mailing Address - Phone:850-201-7177
Mailing Address - Fax:850-201-7101
Practice Address - Street 1:113 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1529
Practice Address - Country:US
Practice Address - Phone:850-201-7177
Practice Address - Fax:850-201-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL475631294OtherTRICARE
FL016318000Medicaid