Provider Demographics
NPI:1417718727
Name:FOOTPRINTS IN THE SAND COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:FOOTPRINTS IN THE SAND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:NEFF
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-257-3346
Mailing Address - Street 1:1004 N ANOKA AVE
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2506
Mailing Address - Country:US
Mailing Address - Phone:863-257-3346
Mailing Address - Fax:
Practice Address - Street 1:2600 N HIGHLANDS BLVD BLDG 1000
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9331
Practice Address - Country:US
Practice Address - Phone:863-572-2992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty