Basic Information
Provider Information | |||||||||
NPI: | 1063822245 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FAMILY COUNSELING ASSOCIATES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4425 MILITARY TRL | ||||||||
Address2: | SUITE 203 | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334584819 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617472775 | ||||||||
FaxNumber: | 5617471881 | ||||||||
Practice Location | |||||||||
Address1: | 4425 MILITARY TRL | ||||||||
Address2: | SUITE 203 | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334584819 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617472775 | ||||||||
FaxNumber: | 5617471881 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2014 | ||||||||
LastUpdateDate: | 04/28/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GUILLORY | ||||||||
AuthorizedOfficialFirstName: | GAIL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5617472775 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH12503 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.