Provider Demographics
NPI:1811352131
Name:COFFEE COUNSELING, COACHING, & CONSULTING
Entity type:Organization
Organization Name:COFFEE COUNSELING, COACHING, & CONSULTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MAGNUSSON
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PHD, ABD
Authorized Official - Phone:407-644-4911
Mailing Address - Street 1:350 FITZHUGH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3537
Mailing Address - Country:US
Mailing Address - Phone:407-644-4911
Mailing Address - Fax:407-644-4911
Practice Address - Street 1:2180 N PARK AVE STE 220
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2358
Practice Address - Country:US
Practice Address - Phone:407-644-4911
Practice Address - Fax:407-644-4911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COFFEE COUNSELING, COACHING, & CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty