Provider Demographics
NPI:1255827838
Name:ELEMENTAL COUNSELING AND CONSULTATION INC.
Entity Type:Organization
Organization Name:ELEMENTAL COUNSELING AND CONSULTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TORREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALGLEISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-353-0660
Mailing Address - Street 1:3590 NE LINDA DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3951
Mailing Address - Country:US
Mailing Address - Phone:772-353-0660
Mailing Address - Fax:
Practice Address - Street 1:416 SE BALBOA AVE STE 2B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2351
Practice Address - Country:US
Practice Address - Phone:772-353-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15801261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)