Provider Demographics
NPI:1770271884
Name:PROACTIVE COUNSELING SOLUTIONS LLC
Entity type:Organization
Organization Name:PROACTIVE COUNSELING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TASSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-345-9225
Mailing Address - Street 1:1600 W EAU GALLIE BLVD STE 201R
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4149
Mailing Address - Country:US
Mailing Address - Phone:321-345-9225
Mailing Address - Fax:
Practice Address - Street 1:1600 W EAU GALLIE BLVD STE 201R
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4149
Practice Address - Country:US
Practice Address - Phone:321-345-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty