Provider Demographics
NPI:1932656329
Name:TAMPA BAY CLINICAL COUNSELING GROUP PLLC
Entity Type:Organization
Organization Name:TAMPA BAY CLINICAL COUNSELING GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAATSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-734-5672
Mailing Address - Street 1:408 W RENFRO ST STE 107F
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-5298
Mailing Address - Country:US
Mailing Address - Phone:813-734-5672
Mailing Address - Fax:
Practice Address - Street 1:408 W RENFRO ST STE 107F
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-5298
Practice Address - Country:US
Practice Address - Phone:813-734-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13522101YM0800X
FL768543101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty