Provider Demographics
NPI:1851638951
Name:CORVEN COUNSELING SERVICES
Entity Type:Organization
Organization Name:CORVEN COUNSELING SERVICES
Other - Org Name:KERRY CORVEN SHELL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:CORVEN
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,EDS,MS,NCC
Authorized Official - Phone:850-509-5808
Mailing Address - Street 1:3201 SHAMROCK ST S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3321
Mailing Address - Country:US
Mailing Address - Phone:850-509-5808
Mailing Address - Fax:
Practice Address - Street 1:3201 SHAMROCK ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3321
Practice Address - Country:US
Practice Address - Phone:850-509-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty