Provider Demographics
NPI:1578021655
Name:INDIGO COUNSELING LLC
Entity Type:Organization
Organization Name:INDIGO COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:BLAIRE
Authorized Official - Last Name:POLLAK FELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-603-8181
Mailing Address - Street 1:3005 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5630
Mailing Address - Country:US
Mailing Address - Phone:813-603-8181
Mailing Address - Fax:
Practice Address - Street 1:3005 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5630
Practice Address - Country:US
Practice Address - Phone:813-603-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty