Basic Information
| Provider Information | |||||||||
| NPI: | 1023140381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY COUNSELING ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 MILITARY TRAIL | ||||||||
| Address2: | STE 203 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334584817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617472775 | ||||||||
| FaxNumber: | 5617471881 | ||||||||
| Practice Location | |||||||||
| Address1: | 4425 MILITARY TRAIL | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334584817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617472775 | ||||||||
| FaxNumber: | 5617471881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | GUILLORY | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | DIANE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617472775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4347 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4786 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW 4901 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW 5367 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW 6254 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW5740 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | Z071W | 01 | FL | MELISSA FEIN, LCSW BCBS# | OTHER | Z8250 | 01 | FL | JULIE AKERS, LCSW BCBS # | OTHER | Z013L | 01 | FL | H KENDRIGAN,LCSW BCBS# | OTHER | Z7718 | 01 | FL | GAIL GUILLORY, LCSW BCBS# | OTHER | Z087N | 01 | FL | ELISA FRALEY, LCSW BCBS # | OTHER | Z120N | 01 | FL | N STEINFELD, LCSW BCBS# | OTHER | Z121J | 01 | FL | BCBSFL PA GROUP # | OTHER |