Healthcare Provider Details

I. General information

NPI: 1649926734
Provider Name (Legal Business Name): SRQ COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N TAMIAMI TRL UNIT 205B
SARASOTA FL
34236-2414
US

IV. Provider business mailing address

1258 14TH ST
SARASOTA FL
34236-2506
US

V. Phone/Fax

Practice location:
  • Phone: 727-488-3459
  • Fax:
Mailing address:
  • Phone: 727-488-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA NOBLE
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 727-488-3459