Provider Demographics
NPI:1710009873
Name:COMPLETE COUNSELING GROUP, INC.
Entity Type:Organization
Organization Name:COMPLETE COUNSELING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-732-5418
Mailing Address - Street 1:333 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4010
Mailing Address - Country:US
Mailing Address - Phone:954-732-5418
Mailing Address - Fax:954-772-1023
Practice Address - Street 1:3115 NW 10TH TER STE 103
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5937
Practice Address - Country:US
Practice Address - Phone:954-236-6676
Practice Address - Fax:954-772-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5538103T00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0613Medicare ID - Type Unspecified