MR. ED'S CIRCLE OF TRUST, INC.
4404 S. FLORIDA AVE. SUITE 14
LAKELAND, FLORIDA 33813
PHONE: (863) 583-4766
FAX: (850) 270-6733
MEDICAID PROVIDER ID- 116677300
PRACTICE TYPE- GROUP PRACTICE
PROVIDER TYPE- 07 SPECIALIZED THERAPEUTIC SERVICES
PROVIDER SPECIALTY- 066 COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT
NPI #- 1194356386
DR. ED SHOEMAKER, PHD, LMHC, QS, TF-CBT
4404 S. FLORIDA AVE. SUITE 14
LAKELAND, FLORIDA 33813
PHONE: (863) 583-4766
FAX: (850) 270-6733
MEDICAID PROVIDER ID- 101349300
PRACTICE TYPE- INDIVIDUAL
PROVIDER TYPE- 07 SPECIALIZED THERAPEUTIC SERVICES
PROVIDER SPECIALTY- 907 SPECIALIZED THERAPEUTIC SERVICES
NPI #- 1447408166
FLORIDA LICENSE- LICENSED MENTAL HEALTH COUNSELOR/QUALIFIED SUPERVISOR MH13244