Provider Demographics
NPI:1710942347
Name:SOUTHEAST PSYCHOLOGICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:SOUTHEAST PSYCHOLOGICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYCHOLOGIST
Authorized Official - Phone:352-338-0077
Mailing Address - Street 1:5200 NW 43RD ST., SUITE 102 #254
Mailing Address - Street 2:SOUTHEAST PSYCHOLOGICAL CONSULTING LLC
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4486
Mailing Address - Country:US
Mailing Address - Phone:352-338-0077
Mailing Address - Fax:352-372-6910
Practice Address - Street 1:4723B NW 53RD AVE, SUITE B
Practice Address - Street 2:SOUTHEAST PSYCHOLOGICAL CONSULTING LLC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653
Practice Address - Country:US
Practice Address - Phone:352-338-0077
Practice Address - Fax:352-372-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC0700X, 103TC1900X, 103TE1100X, 103TF0200X, 103TP0814X
FLPY5139103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0619Medicare PIN
FL59638Medicare ID - Type Unspecified