Provider Demographics
NPI:1629323423
Name:ENVISION COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ENVISION COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALERICO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-567-6207
Mailing Address - Street 1:9030 58TH DR E
Mailing Address - Street 2:STE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6108
Mailing Address - Country:US
Mailing Address - Phone:941-567-6207
Mailing Address - Fax:941-727-2741
Practice Address - Street 1:9030 58TH DR E
Practice Address - Street 2:STE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6108
Practice Address - Country:US
Practice Address - Phone:941-567-6207
Practice Address - Fax:941-727-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8857101YM0800X
FLMH9081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty