Provider Demographics
NPI:1245757350
Name:TREE OF LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:TREE OF LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:N
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, CAP
Authorized Official - Phone:954-947-0774
Mailing Address - Street 1:2755 E OAKLAND PARK BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1637
Mailing Address - Country:US
Mailing Address - Phone:954-947-0774
Mailing Address - Fax:
Practice Address - Street 1:2755 E OAKLAND PARK BLVD STE 302-1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1637
Practice Address - Country:US
Practice Address - Phone:954-947-0774
Practice Address - Fax:954-947-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407232291Medicaid