Provider Demographics
NPI:1558752642
Name:NEXTEP COUNSELING AND CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:NEXTEP COUNSELING AND CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-362-0710
Mailing Address - Street 1:6313 CORPORATE CT STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3509
Mailing Address - Country:US
Mailing Address - Phone:239-362-0144
Mailing Address - Fax:
Practice Address - Street 1:6313 CORPORATE CT STE 130
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3509
Practice Address - Country:US
Practice Address - Phone:239-362-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL2036AD6563-01261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health