Provider Demographics
NPI:1487023669
Name:MANATEE COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:MANATEE COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:EMERSON-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PHD
Authorized Official - Phone:260-409-9845
Mailing Address - Street 1:6349 EVARO AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-1015
Mailing Address - Country:US
Mailing Address - Phone:260-409-9845
Mailing Address - Fax:
Practice Address - Street 1:1284 LORI DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4561
Practice Address - Country:US
Practice Address - Phone:260-409-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW123981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083958474Medicare PIN
FL1730499347Medicare PIN