Healthcare Provider Details

I. General information

NPI: 1124155742
Provider Name (Legal Business Name): TLC COACHING & COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 W PALMETTO PARK ROAD SUITE 250A
BOCA RATON FL
33434-6797
US

IV. Provider business mailing address

10972 LA SALINAS CIR
BOCA RATON FL
33428-1237
US

V. Phone/Fax

Practice location:
  • Phone: 561-929-4727
  • Fax:
Mailing address:
  • Phone: 561-929-4727
  • Fax: 561-482-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 6098
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 6098
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberMH 6098
License Number StateFL

VIII. Authorized Official

Name: TINA D CONNAN
Title or Position: LMHC
Credential: LMHC
Phone: 561-929-4727