Provider Demographics
NPI:1710624101
Name:SUNRISE COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:SUNRISE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:POZZI-MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PHD
Authorized Official - Phone:407-205-5589
Mailing Address - Street 1:6939 GREEN SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-9729
Mailing Address - Country:US
Mailing Address - Phone:140-720-5558
Mailing Address - Fax:
Practice Address - Street 1:297 E HIGHWAY 50 STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2500
Practice Address - Country:US
Practice Address - Phone:407-205-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1019414110002Medicaid