Provider Demographics
NPI:1558686170
Name:TREASURE COAST COUNSELING CENTER INC
Entity Type:Organization
Organization Name:TREASURE COAST COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FETCHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-335-9808
Mailing Address - Street 1:2400 SE VETRANS MEMORIAL PARKWAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5033
Mailing Address - Country:US
Mailing Address - Phone:772-335-9808
Mailing Address - Fax:772-335-9818
Practice Address - Street 1:2400 SE VETRANS MEMORIAL PARKWAY
Practice Address - Street 2:SUITE 211
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5033
Practice Address - Country:US
Practice Address - Phone:772-335-9808
Practice Address - Fax:772-335-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1956AD091301261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder