Provider Demographics
NPI:1093302747
Name:BOUNDLESS LIVING COACHING COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:BOUNDLESS LIVING COACHING COUNSELING & CONSULTING
Other - Org Name:THE NOIR CENTER FOR INTUITIVE HEALING & COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORTINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC
Authorized Official - Phone:561-315-5939
Mailing Address - Street 1:1964 HOWELL BRANCH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1042
Mailing Address - Country:US
Mailing Address - Phone:561-315-5939
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH RD STE 110
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:561-315-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285925578Medicaid