Healthcare Provider Details

I. General information

NPI: 1225321409
Provider Name (Legal Business Name): PSYCHOLOGY AND COUNSELING GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PARK CENTER DR SUITE 270
ORLANDO FL
32835-7626
US

IV. Provider business mailing address

2101 PARK CENTER DR SUITE 270
ORLANDO FL
32835-7626
US

V. Phone/Fax

Practice location:
  • Phone: 407-523-1213
  • Fax: 407-523-2398
Mailing address:
  • Phone: 407-523-1213
  • Fax: 407-523-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GAIL W. MOCK
Title or Position: OWNER
Credential: PSY.D.
Phone: 407-523-1213