Healthcare Provider Details

I. General information

NPI: 1578077335
Provider Name (Legal Business Name): SEYLA COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TANRSROCK LAKE BLVD SUITE 400
ORLANDO FL
32827
US

IV. Provider business mailing address

PO BOX 410162
MELBOURNE FL
32941
US

V. Phone/Fax

Practice location:
  • Phone: 321-677-2789
  • Fax:
Mailing address:
  • Phone: 321-677-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY10004
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number002722
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002722
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY10004
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number002722
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY10004
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number002722
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10004
License Number StateFL

VIII. Authorized Official

Name: DR. KEVIN MERTENS
Title or Position: OWNER/PRESIDENT
Credential: PHD
Phone: 321-677-2789