Provider Demographics
NPI:1609446558
Name:EPIPHANY COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:EPIPHANY COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAUTRESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-451-1336
Mailing Address - Street 1:3601 SW 2ND AVE STE R
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2802
Mailing Address - Country:US
Mailing Address - Phone:352-451-1336
Mailing Address - Fax:
Practice Address - Street 1:3601 SW 2ND AVE STE R
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2802
Practice Address - Country:US
Practice Address - Phone:352-451-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty