Provider Demographics
NPI:1780059865
Name:FOUR SEASONS COUNSELING,LLC
Entity type:Organization
Organization Name:FOUR SEASONS COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER.
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-557-7975
Mailing Address - Street 1:2933 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3451
Mailing Address - Country:US
Mailing Address - Phone:850-557-7975
Mailing Address - Fax:
Practice Address - Street 1:2933 MADISON ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3451
Practice Address - Country:US
Practice Address - Phone:850-557-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty