Healthcare Provider Details

I. General information

NPI: 1972821627
Provider Name (Legal Business Name): WEBB - RAUCKHORST COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 ULMERTON RD STE 7A
LARGO FL
33771-3522
US

IV. Provider business mailing address

10225 ULMERTON RD STE 7A
LARGO FL
33771-3522
US

V. Phone/Fax

Practice location:
  • Phone: 727-474-3740
  • Fax: 727-474-3741
Mailing address:
  • Phone: 727-474-3740
  • Fax: 727-474-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5457
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1816
License Number StateFL

VIII. Authorized Official

Name: MRS. JUDY MARION RAUCKHORST
Title or Position: CEO
Credential: LCSW
Phone: 727-474-3740