Provider Demographics
NPI:1902037013
Name:EMERALD COAST ASSESSMENT AND COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:EMERALD COAST ASSESSMENT AND COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDS , NCSP
Authorized Official - Phone:866-960-8806
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE 38
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:866-960-8806
Mailing Address - Fax:866-960-8806
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:SUITE 38
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:866-960-8806
Practice Address - Fax:866-960-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8518101YM0800X
FLSS795103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty