Provider Demographics
NPI:1417514720
Name:FOUR WINDS COUNSELING LLC
Entity Type:Organization
Organization Name:FOUR WINDS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:APOLLO
Authorized Official - Last Name:DESCISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-817-2709
Mailing Address - Street 1:12309 CLOVERSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624
Mailing Address - Country:US
Mailing Address - Phone:813-817-2709
Mailing Address - Fax:813-968-7370
Practice Address - Street 1:611 WEST BAY STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-817-2709
Practice Address - Fax:813-968-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty