Provider Demographics
NPI:1982961835
Name:GULF SHORES COUNSELING CENTER
Entity Type:Organization
Organization Name:GULF SHORES COUNSELING CENTER
Other - Org Name:SOUTHWEST FLORIDA COUNSELING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-391-1399
Mailing Address - Street 1:2970 UNIVERSITY PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2401
Mailing Address - Country:US
Mailing Address - Phone:941-391-1399
Mailing Address - Fax:
Practice Address - Street 1:2970 UNIVERSITY PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2401
Practice Address - Country:US
Practice Address - Phone:941-391-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041C0700X, 251S00000X
FLSW-102951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGC731AMedicare PIN