Provider Demographics
NPI:1629883665
Name:ELYSIAN LIFE COACHING AND COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:ELYSIAN LIFE COACHING AND COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW INTERN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW INTERN
Authorized Official - Phone:863-266-6024
Mailing Address - Street 1:340 W CENTRAL AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 W CENTRAL AVE STE 330
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2967
Practice Address - Country:US
Practice Address - Phone:863-266-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty