Basic Information
| Provider Information | |||||||||
| NPI: | 1346513751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEST LIFE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W INDIANTOWN RD | ||||||||
| Address2: | 107 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334586830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617458889 | ||||||||
| FaxNumber: | 5613540189 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 W INDIANTOWN RD | ||||||||
| Address2: | 107 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334586830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617458889 | ||||||||
| FaxNumber: | 5613540189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2012 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BENAIM | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5617458889 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | MH10942 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 261QR0405X | 1550AD982501 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | Z03LX | 01 | FL | BC/BS | OTHER |