Provider Demographics
NPI:1588860670
Name:NEUROPSYCHOLOGY & COUNSELING SERVICES PA
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY & COUNSELING SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ESTILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-253-9348
Mailing Address - Street 1:101 E MAUD ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3249
Mailing Address - Country:US
Mailing Address - Phone:352-253-9348
Mailing Address - Fax:352-253-9351
Practice Address - Street 1:101 E MAUD ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3249
Practice Address - Country:US
Practice Address - Phone:352-253-9348
Practice Address - Fax:352-253-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-04-14
Deactivation Date:2007-09-14
Deactivation Code:
Reactivation Date:2008-01-29
Provider Licenses
StateLicense IDTaxonomies
FLPY3993103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI295Medicare PIN