Provider Demographics
NPI:1366501512
Name:VISTA EMPLOYEE ASSISTANCE & COUNSELING INC
Entity Type:Organization
Organization Name:VISTA EMPLOYEE ASSISTANCE & COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-324-9440
Mailing Address - Street 1:101 TIMBERLACHEN CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6124
Mailing Address - Country:US
Mailing Address - Phone:407-324-9440
Mailing Address - Fax:407-330-5244
Practice Address - Street 1:101 TIMBERLACHEN CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6124
Practice Address - Country:US
Practice Address - Phone:407-324-9440
Practice Address - Fax:407-330-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW0020241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336128834OtherNPI INDIVIDUAL
FLZ4208OtherBCBS
FL=========OtherEIN