Provider Demographics
NPI:1780614826
Name:THE GROVE COUNSELING CENTER INC
Entity type:Organization
Organization Name:THE GROVE COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-327-1765
Mailing Address - Street 1:111 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4130
Mailing Address - Country:US
Mailing Address - Phone:407-327-1765
Mailing Address - Fax:407-339-2129
Practice Address - Street 1:111 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4130
Practice Address - Country:US
Practice Address - Phone:407-327-1765
Practice Address - Fax:407-339-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL216457OtherAMERIGROUP #
FL122945OtherVALUE OPTIONS #
FL331964OtherMHN, INC.
FLS2AOtherBLUE CROSS BLUE SHIELD
FL0295965Medicaid
FL44248OtherCIGNA PROVIDER #
FL208983OtherHARMONY HEALTH