| Out Of The Blue Counseling Llc | |
|
12140 Nw 77th Mnr Parkland FL 33076-4516 | |
| (954) 294-3758 | |
| Not Available |
| Full Name | Out Of The Blue Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 12140 Nw 77th Mnr, Parkland, Florida |
| Authorized Official Name and Position | Stephen Eric Bradbery (OWNER) |
| Authorized Official Contact | 9542943758 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Out Of The Blue Counseling Llc 12140 Nw 77th Mnr Parkland FL 33076-4516 Ph: (954) 294-3758 | Out Of The Blue Counseling Llc 12140 Nw 77th Mnr Parkland FL 33076-4516 Ph: (954) 294-3758 |
| NPI Number | 1902526981 |
|---|---|
| Provider Enumeration Date | 08/31/2022 |
| Last Update Date | 08/31/2022 |
| Certification Date | 08/15/2022 |
| Medicare PECOS PAC ID | 1951843671 |
|---|---|
| Medicare Enrollment ID | O20240610003428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902526981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stephen Eric Bradbery |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730755851 PECOS PAC ID: 0042661654 Enrollment ID: I20240108006116 |
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