Provider Demographics
NPI:1225321409
Name:PSYCHOLOGY AND COUNSELING GROUP, LLP
Entity Type:Organization
Organization Name:PSYCHOLOGY AND COUNSELING GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-523-1213
Mailing Address - Street 1:2101 PARK CENTER DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7626
Mailing Address - Country:US
Mailing Address - Phone:407-523-1213
Mailing Address - Fax:407-523-2398
Practice Address - Street 1:2101 PARK CENTER DR
Practice Address - Street 2:SUITE 270
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7626
Practice Address - Country:US
Practice Address - Phone:407-523-1213
Practice Address - Fax:407-523-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21491Medicare UPIN