Provider Demographics
NPI:1679011449
Name:DIRECT ACCESS COUNSELING & SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:DIRECT ACCESS COUNSELING & SUPPORTIVE SERVICES, LLC
Other - Org Name:DIRECT ACCESS COUNSELING AND SUPPORTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-652-0260
Mailing Address - Street 1:223 E OAK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-4445
Mailing Address - Country:US
Mailing Address - Phone:239-652-0260
Mailing Address - Fax:239-652-0146
Practice Address - Street 1:223 E OAK ST APT 3
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4445
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:239-652-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty