Provider Demographics
NPI:1629850078
Name:ST LUCIE COUNSELING AND CLINICAL HYPNOSIS, LLC
Entity Type:Organization
Organization Name:ST LUCIE COUNSELING AND CLINICAL HYPNOSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BABKIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:203-856-3600
Mailing Address - Street 1:10293 SW VILLAGE PKWY APT 304
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2373
Mailing Address - Country:US
Mailing Address - Phone:203-856-3600
Mailing Address - Fax:
Practice Address - Street 1:1860 SW FOUNTAINVIEW BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:203-856-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty