Provider Demographics
NPI:1326475708
Name:LAKELAND COUNSELING LLC
Entity Type:Organization
Organization Name:LAKELAND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-614-0034
Mailing Address - Street 1:PO BOX 91872
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1872
Mailing Address - Country:US
Mailing Address - Phone:863-614-0034
Mailing Address - Fax:863-937-0284
Practice Address - Street 1:3221 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4550
Practice Address - Country:US
Practice Address - Phone:863-614-0034
Practice Address - Fax:863-937-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1073508305OtherNPI