Provider Demographics
NPI:1538295860
Name:WEST ORANGE COUNSELING LLC
Entity Type:Organization
Organization Name:WEST ORANGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-877-8074
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:301 N TUBB ST
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760-1225
Mailing Address - Country:US
Mailing Address - Phone:407-877-8074
Mailing Address - Fax:407-877-0410
Practice Address - Street 1:301 N TUBB ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-1225
Practice Address - Country:US
Practice Address - Phone:407-877-8074
Practice Address - Fax:407-877-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3983103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9440Medicare ID - Type Unspecified