Healthcare Provider Details

I. General information

NPI: 1932656329
Provider Name (Legal Business Name): TAMPA BAY CLINICAL COUNSELING GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W RENFRO ST STE 107F
PLANT CITY FL
33563-5298
US

IV. Provider business mailing address

408 W RENFRO ST STE 107F
PLANT CITY FL
33563-5298
US

V. Phone/Fax

Practice location:
  • Phone: 813-734-5672
  • Fax:
Mailing address:
  • Phone: 813-734-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number768543
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 13522
License Number StateFL

VIII. Authorized Official

Name: DR. JOEL M LAATSCH
Title or Position: OWNER
Credential: LMHC
Phone: 813-734-5672