Provider Demographics
NPI:1558729616
Name:PURPLE CACTUS COUNSELING LLC
Entity Type:Organization
Organization Name:PURPLE CACTUS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-625-0808
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0026
Mailing Address - Country:US
Mailing Address - Phone:407-625-0808
Mailing Address - Fax:
Practice Address - Street 1:4415 FLORIDA NATIONAL DR STE 214
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1573
Practice Address - Country:US
Practice Address - Phone:407-625-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty