Provider Demographics
NPI:1457955130
Name:TGK COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:TGK COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-KURZY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC-S, NCC
Authorized Official - Phone:941-564-7987
Mailing Address - Street 1:1317 EDGEWATER DR # 580
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:941-564-7987
Mailing Address - Fax:941-761-5815
Practice Address - Street 1:1317 EDGEWATER DR # 580
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:941-564-7987
Practice Address - Fax:941-761-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12758890OtherCAQU
FL013793100Medicaid