Provider Demographics
NPI:1003876400
Name:FAMILY COUNSELING CENTER OF BREVARD INC
Entity type:Organization
Organization Name:FAMILY COUNSELING CENTER OF BREVARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:321-632-5972
Mailing Address - Street 1:505 BREVARD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7973
Mailing Address - Country:US
Mailing Address - Phone:321-632-5792
Mailing Address - Fax:321-632-5796
Practice Address - Street 1:505 BREVARD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7973
Practice Address - Country:US
Practice Address - Phone:321-632-5792
Practice Address - Fax:321-632-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275892OtherWELLCARE
FL285955OtherAMERIGROUP
FLZ067ROtherBLUE CROSS BLUE SHIELD
FL060332500Medicaid
FL060332502Medicaid
FLX0461OtherBLUE CROSS BLUE SHIELD
FL275892OtherWELLCARE
FL275892OtherWELLCARE