Provider Demographics
NPI:1760913909
Name:DEBORAH BASEDOW COUNSELING
Entity Type:Organization
Organization Name:DEBORAH BASEDOW COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BASEDOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC NCC
Authorized Official - Phone:727-698-1806
Mailing Address - Street 1:2729 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-4015
Mailing Address - Country:US
Mailing Address - Phone:727-698-1806
Mailing Address - Fax:813-902-6081
Practice Address - Street 1:911 S PARSONS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6070
Practice Address - Country:US
Practice Address - Phone:727-698-1806
Practice Address - Fax:813-902-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty