Space Coast Counseling Center, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SPACE COAST COUNSELING CENTER, INC.

Practice address

166 Center St Ste 239
Cape Canaveral, FL 32920-3717

Phone

(321) 267-2288

Fax

(866) 703-0035

NPI assigned

Mar 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lana Lynn Beasley, MA, LMHCNPI 1275675688

Title

President

Phone

(321) 267-2228

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lana Lynn Beasley, MA, LMHC

  • Mental Health Counselor
  • Cape Canaveral, FL
  • NPI 1275675688
  Medicare reassignment NPD Authorized official
• Daniel J. Resh Jr., LMHC

  • Mental Health Counselor
  • Titusville, FL
  • NPI 1063634384
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1316070345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1284",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329201284",
            "telephone_number": "321-267-2288",
            "fax_number": "866-703-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 CENTER ST STE 239",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329203717",
            "telephone_number": "321-267-2288",
            "fax_number": "866-703-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST COUNSELING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "LANA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-267-2228",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00493900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113658100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ridgemoor Case Management Services Inc.
• Grace Rodes, RPH
• Alejandro Javier Romero, IDHS
• Lijah Lyndon Rosario
• Julian Benedict Salido, IDHS
• Luke Cole Ulmaniec, IDHS
• Ashley Vaden, RDN
• Mary Ward
• Steven Mark Warner, PHD
• Edward James Weiss, D.D.S.

• Mental Health Counselor in Cape Canaveral, FL
• Providers in Cape Canaveral, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.