Provider Demographics
NPI:1184397242
Name:SG MENTAL HEALTH COUNSELING
Entity type:Organization
Organization Name:SG MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER'S LEVEL CLINICAN
Authorized Official - Prefix:
Authorized Official - First Name:KENYETTA
Authorized Official - Middle Name:SHANANEY
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MSW
Authorized Official - Phone:850-727-9881
Mailing Address - Street 1:1374-A CROSS CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301
Mailing Address - Country:US
Mailing Address - Phone:850-425-0206
Mailing Address - Fax:
Practice Address - Street 1:1375A CROSS CREEK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3729
Practice Address - Country:US
Practice Address - Phone:850-425-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)