Provider Demographics
NPI:1700252509
Name:COUNSELING & PSYCHOLOGICAL SERVICES OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:COUNSELING & PSYCHOLOGICAL SERVICES OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-347-0661
Mailing Address - Street 1:310 S DILLARD ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3587
Mailing Address - Country:US
Mailing Address - Phone:407-347-0661
Mailing Address - Fax:
Practice Address - Street 1:310 S DILLARD ST
Practice Address - Street 2:SUITE 190
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3587
Practice Address - Country:US
Practice Address - Phone:407-347-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8941261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health