1962790121 NPI number — KLA COUNSELING SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962790121 NPI number — KLA COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLA COUNSELING SERVICES, INC.
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:
1962790121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4653 SW BERMUDA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34990-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-233-4282
Provider Business Mailing Address Fax Number:
772-248-1358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 NW FEDERAL HWY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-233-4282
Provider Business Practice Location Address Fax Number:
772-248-1358
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AGULIA
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
PARRIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-233-4282

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MH 9214 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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