Provider Demographics
NPI:1629525803
Name:PALM AVENUE COUNSELING, PLLC
Entity Type:Organization
Organization Name:PALM AVENUE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:KELSEY
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-338-5514
Mailing Address - Street 1:47 S PALM AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5699
Mailing Address - Country:US
Mailing Address - Phone:646-338-5514
Mailing Address - Fax:
Practice Address - Street 1:47 S PALM AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5699
Practice Address - Country:US
Practice Address - Phone:646-338-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW120011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty