Provider Demographics
NPI:1184460800
Name:COFFEE CUP COUNSELING LLC
Entity type:Organization
Organization Name:COFFEE CUP COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC/LMFT
Authorized Official - Phone:386-490-5618
Mailing Address - Street 1:22440 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8805
Mailing Address - Country:US
Mailing Address - Phone:386-490-5618
Mailing Address - Fax:
Practice Address - Street 1:851 N DONNELLY ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-4835
Practice Address - Country:US
Practice Address - Phone:321-209-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health