Healthcare Provider Details

I. General information

NPI: 1316628886
Provider Name (Legal Business Name): FLOWING WISDOM MENTAL HEALTH COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 SEABERG RD
ZEPHYRHILLS FL
33541-2862
US

IV. Provider business mailing address

18448 CORTES CREEK BLVD
SPRING HILL FL
34610-0120
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-6592
  • Fax:
Mailing address:
  • Phone: 815-278-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY CAVALL
Title or Position: OWNER
Credential: LMHC
Phone: 954-649-6592