Healthcare Provider Details

I. General information

NPI: 1265922017
Provider Name (Legal Business Name): MAITRI COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S OSCEOLA AVE
INVERNESS FL
34452-4727
US

IV. Provider business mailing address

5700 S UTOPIA TER
INVERNESS FL
34452-8568
US

V. Phone/Fax

Practice location:
  • Phone: 561-202-5532
  • Fax:
Mailing address:
  • Phone: 561-202-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER ANN CHAMPION
Title or Position: OWNER
Credential: MA, LMHC
Phone: 561-231-8860