Provider Demographics
NPI:1851630180
Name:HIBISCUS COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:HIBISCUS COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:MAGALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-249-8255
Mailing Address - Street 1:1981 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5555
Mailing Address - Country:US
Mailing Address - Phone:772-249-8255
Mailing Address - Fax:772-249-8256
Practice Address - Street 1:549 SE STARFLOWER AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4578
Practice Address - Country:US
Practice Address - Phone:772-249-8255
Practice Address - Fax:772-249-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDI480ZOtherPTAN