Healthcare Provider Details

I. General information

NPI: 1821455916
Provider Name (Legal Business Name): COUNSELING CENTER & HUMAN SEXUALITY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 TIM GAMBLE PLACE 2ND FLOOR
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

2450 TIM GAMBLE PLACE 2ND FLOOR
TALLAHASSEE FL
32308
US

V. Phone/Fax

Practice location:
  • Phone: 850-656-2100
  • Fax: 850-656-2130
Mailing address:
  • Phone: 850-656-2100
  • Fax: 850-656-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW2363
License Number StateFL

VIII. Authorized Official

Name: DR. LINDA HUMPHRIES
Title or Position: OWNER
Credential: MSW, LCSW, PHD
Phone: 850-656-2100