Provider Demographics
NPI:1114340635
Name:EMR COUNSELING & THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:EMR COUNSELING & THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:407-265-2100
Mailing Address - Street 1:341 N MAITLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4783
Mailing Address - Country:US
Mailing Address - Phone:407-265-2100
Mailing Address - Fax:407-265-2872
Practice Address - Street 1:341 N MAITLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4783
Practice Address - Country:US
Practice Address - Phone:407-265-2100
Practice Address - Fax:407-265-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 11985OtherSTATE OF FLORIDA, DEPARTMENT OF HEALTH LICENSE