Provider Demographics
NPI:1376930362
Name:START FRESH COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:START FRESH COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MHC,CBHCMS
Authorized Official - Phone:813-489-4546
Mailing Address - Street 1:135 N MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4419
Mailing Address - Country:US
Mailing Address - Phone:813-489-4547
Mailing Address - Fax:
Practice Address - Street 1:135 N MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4419
Practice Address - Country:US
Practice Address - Phone:813-489-4547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:START FRESH COUNSELING CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-17
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015050400Medicaid