| 180 Counseling Group Llc | |
|
4143 Day Bridge Pl Ellenton FL 34222-7236 | |
| (941) 348-4059 | |
| (941) 803-4215 |
| Full Name | 180 Counseling Group Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4143 Day Bridge Pl, Ellenton, Florida |
| Authorized Official Name and Position | Eddie Collins (OWNER) |
| Authorized Official Contact | 9413484059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 180 Counseling Group Llc 2605 72nd Ave E Unit 583 Ellenton FL 34222-7021 Ph: (941) 348-4059 | 180 Counseling Group Llc 4143 Day Bridge Pl Ellenton FL 34222-7236 Ph: (941) 348-4059 |
| NPI Number | 1821780040 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 12/04/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 8426585993 |
|---|---|
| Medicare Enrollment ID | O20241221000081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821780040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Eddie Lee Collins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700835352 PECOS PAC ID: 8224476494 Enrollment ID: I20240406000400 |
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