1154446110 NPI number — COUNSELING CORNER

Table of content: (NPI 1154446110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154446110 NPI number — COUNSELING CORNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING CORNER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154446110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1630 HILLCREST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-843-4968
Provider Business Mailing Address Fax Number:
407-447-4543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 HILLCREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-843-4968
Provider Business Practice Location Address Fax Number:
407-447-4543
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REILLY
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
407-843-4968

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH5067 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: SW5041 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z105J . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Z001B . This is a "BLUE CROSS PROVIDER NUMBR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Z029R . This is a "BLUE CROSS PROVIDER NUMBR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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