Provider Demographics
NPI:1801345335
Name:BRAINCLICK COUNSELING
Entity type:Organization
Organization Name:BRAINCLICK COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VAN KLEECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:863-214-2046
Mailing Address - Street 1:135 LARGS CT
Mailing Address - Street 2:#308
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8386
Mailing Address - Country:US
Mailing Address - Phone:863-214-2046
Mailing Address - Fax:
Practice Address - Street 1:135 LARGS CT
Practice Address - Street 2:#308
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8386
Practice Address - Country:US
Practice Address - Phone:863-214-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093990016Medicaid