Provider Demographics
NPI:1164880548
Name:ENDURING PEACE COUNSELING LLC
Entity Type:Organization
Organization Name:ENDURING PEACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-738-8538
Mailing Address - Street 1:5110 S FLORIDA AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2517
Mailing Address - Country:US
Mailing Address - Phone:863-738-8538
Mailing Address - Fax:863-510-5903
Practice Address - Street 1:5110 S FLORIDA AVE STE 114
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2517
Practice Address - Country:US
Practice Address - Phone:863-738-8538
Practice Address - Fax:863-510-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13024251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health