Provider Demographics
NPI:1821278680
Name:SOUTHWEST PSYCHOTHERAPY AND COUNSELING CENTER INC
Entity Type:Organization
Organization Name:SOUTHWEST PSYCHOTHERAPY AND COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MURTY-VELAMAKANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW ACSW
Authorized Official - Phone:941-766-8835
Mailing Address - Street 1:22655 BAYSHORE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2018
Mailing Address - Country:US
Mailing Address - Phone:941-766-8835
Mailing Address - Fax:
Practice Address - Street 1:22655 BAYSHORE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2018
Practice Address - Country:US
Practice Address - Phone:941-766-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5984261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4035Medicare UPIN