Provider Demographics
NPI:1932473451
Name:ADULT COUNSELING & PSYCHOTHERAPY OF LAKE COUNTY, LLC
Entity Type:Organization
Organization Name:ADULT COUNSELING & PSYCHOTHERAPY OF LAKE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANGELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DRAD, LMHC, CAP
Authorized Official - Phone:352-742-5665
Mailing Address - Street 1:131 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3809
Mailing Address - Country:US
Mailing Address - Phone:352-742-5665
Mailing Address - Fax:352-343-8801
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3809
Practice Address - Country:US
Practice Address - Phone:352-742-5665
Practice Address - Fax:352-343-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9157101YA0400X, 101YM0800X, 106H00000X
FLSW104701041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty