Provider Demographics
NPI:1841785482
Name:SPENCER COUNSELING & THERAPY
Entity Type:Organization
Organization Name:SPENCER COUNSELING & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAWANZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PROVISION COUNSELOR
Authorized Official - Phone:850-972-9897
Mailing Address - Street 1:6888 PINE FOREST ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2673
Mailing Address - Country:US
Mailing Address - Phone:850-972-9897
Mailing Address - Fax:850-972-9898
Practice Address - Street 1:6866 PINE FOREST RD STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-6903
Practice Address - Country:US
Practice Address - Phone:850-972-9897
Practice Address - Fax:850-972-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841785482Medicaid
FL=========Medicaid