Provider Demographics
NPI:1154446110
Name:COUNSELING CORNER
Entity Type:Organization
Organization Name:COUNSELING CORNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:W
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:407-843-4968
Mailing Address - Street 1:1630 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4810
Mailing Address - Country:US
Mailing Address - Phone:407-843-4968
Mailing Address - Fax:407-447-4543
Practice Address - Street 1:1630 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4810
Practice Address - Country:US
Practice Address - Phone:407-843-4968
Practice Address - Fax:407-447-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5067101YM0800X
FLSW50411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ105JOtherBLUE CROSS GROUP NUMBER
FLZ001BOtherBLUE CROSS PROVIDER NUMBR
FLZ029ROtherBLUE CROSS PROVIDER NUMBR
FLZ105JOtherBLUE CROSS GROUP NUMBER