Provider Demographics
NPI:1841012846
Name:FULL LIFE COUNSELING CENTER
Entity type:Organization
Organization Name:FULL LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEIROS LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC
Authorized Official - Phone:407-529-7662
Mailing Address - Street 1:1347 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5629
Mailing Address - Country:US
Mailing Address - Phone:407-529-7662
Mailing Address - Fax:
Practice Address - Street 1:9764 N ARROWWOOD RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-4703
Practice Address - Country:US
Practice Address - Phone:407-529-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)