Basic Information
| Provider Information | |||||||||
| NPI: | 1891865762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNSELING AND BEHAVIORAL SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 COVE BLVD SUITE A | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505961208 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 N COVE BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324013642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505961208 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUGGAR | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | JEFFERY | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSLOR OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8505961208 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH7162 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | Z012U | 01 | FL | BCBS OF FL | OTHER |