Provider Demographics
NPI:1023479771
Name:FAMILY BUILDERS COUNSELING
Entity type:Organization
Organization Name:FAMILY BUILDERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-432-8295
Mailing Address - Street 1:3077 GREEN TURTLE CIR
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-6515
Mailing Address - Country:US
Mailing Address - Phone:321-432-8295
Mailing Address - Fax:321-267-8491
Practice Address - Street 1:1010 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2747
Practice Address - Country:US
Practice Address - Phone:321-432-8295
Practice Address - Fax:321-267-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8409251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009489800Medicaid
FLZ3111POtherBLUE CROSS/BLUE SHIELD