Provider Demographics
NPI:1255876934
Name:REVEALED COUNSELING CENTER
Entity type:Organization
Organization Name:REVEALED COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/VISIONARY
Authorized Official - Prefix:
Authorized Official - First Name:TD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:561-557-2741
Mailing Address - Street 1:PO BOX 223586
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-3586
Mailing Address - Country:US
Mailing Address - Phone:561-557-2741
Mailing Address - Fax:561-469-2447
Practice Address - Street 1:4610 PORTOFINO WAY
Practice Address - Street 2:207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-8154
Practice Address - Country:US
Practice Address - Phone:561-557-2741
Practice Address - Fax:561-469-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty