Provider Demographics
NPI:1437685310
Name:CLINICAL COUNSELING & CONSULTING P.A.
Entity Type:Organization
Organization Name:CLINICAL COUNSELING & CONSULTING P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP, NCC
Authorized Official - Phone:305-778-5333
Mailing Address - Street 1:6282 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5141
Mailing Address - Country:US
Mailing Address - Phone:786-763-2019
Mailing Address - Fax:
Practice Address - Street 1:4601 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2111
Practice Address - Country:US
Practice Address - Phone:786-763-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
FLMH12372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty