Provider Demographics
NPI:1033665260
Name:FAMILY LIFE COUNSELING CENTER
Entity Type:Organization
Organization Name:FAMILY LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:352-536-4158
Mailing Address - Street 1:1230 OAKLEY SEAVER DR STE 307
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1961
Mailing Address - Country:US
Mailing Address - Phone:352-988-6673
Mailing Address - Fax:352-363-2496
Practice Address - Street 1:1230 OAKLEY SEAVER DR STE 307
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1961
Practice Address - Country:US
Practice Address - Phone:352-988-6673
Practice Address - Fax:352-363-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X, 251S00000X
FLMT3215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty