Provider Demographics
NPI:1932760451
Name:BETH DAVALOS COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:BETH DAVALOS COUNSELING CENTER LLC
Other - Org Name:SUNSHINE SENIOR COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DAVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-401-9020
Mailing Address - Street 1:2725 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-6601
Mailing Address - Country:US
Mailing Address - Phone:407-620-0869
Mailing Address - Fax:
Practice Address - Street 1:540 E HORATIO AVE STE 200
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7314
Practice Address - Country:US
Practice Address - Phone:407-907-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty