Provider Demographics
NPI:1790408300
Name:BIRCH COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BIRCH COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:MEOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-791-0452
Mailing Address - Street 1:14640 ADINA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5737
Mailing Address - Country:US
Mailing Address - Phone:239-791-0452
Mailing Address - Fax:
Practice Address - Street 1:14640 ADINA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5737
Practice Address - Country:US
Practice Address - Phone:239-791-0452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health