Provider Demographics
NPI:1992366553
Name:COUNSELOGY, LLC
Entity Type:Organization
Organization Name:COUNSELOGY, LLC
Other - Org Name:THE BEHAVIORAL CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:310-220-3122
Mailing Address - Street 1:776 SAINT ALBANS DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1519
Mailing Address - Country:US
Mailing Address - Phone:310-220-3122
Mailing Address - Fax:310-220-3123
Practice Address - Street 1:7100 WEST CAMINO REAL
Practice Address - Street 2:STE 404
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-221-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty