Healthcare Provider Details

I. General information

NPI: 1700252509
Provider Name (Legal Business Name): COUNSELING & PSYCHOLOGICAL SERVICES OF CENTRAL FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S DILLARD ST SUITE 190
WINTER GARDEN FL
34787-3587
US

IV. Provider business mailing address

310 S DILLARD ST SUITE 190
WINTER GARDEN FL
34787-3587
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-0661
  • Fax:
Mailing address:
  • Phone: 407-347-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberPY8941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY8941
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPY8941
License Number StateFL

VIII. Authorized Official

Name: DR. PARKER LEE MOTT
Title or Position: OWNER/PRESIDENT/PSYCHOLOGIST
Credential: PSY.D.
Phone: 407-347-0661