Provider Demographics
NPI:1992554885
Name:VISTA COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:VISTA COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMHC
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-475-4265
Mailing Address - Street 1:681 BALLARD DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6901
Mailing Address - Country:US
Mailing Address - Phone:321-475-4265
Mailing Address - Fax:
Practice Address - Street 1:2955 PINEDA PLAZA WAY STE 117
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7306
Practice Address - Country:US
Practice Address - Phone:321-475-4265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty