Provider Demographics
NPI:1245064955
Name:HYBRID COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:HYBRID COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNALIESE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-890-2182
Mailing Address - Street 1:4429 SW COUNTY ROAD 344
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-1781
Mailing Address - Country:US
Mailing Address - Phone:352-890-2182
Mailing Address - Fax:
Practice Address - Street 1:2469 N YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-9181
Practice Address - Country:US
Practice Address - Phone:352-890-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)