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General NPI Number Information
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NPI Number | 1114466570
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FLORIDA COUNSELING SERVICES
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 8931 CONFERENCE DR
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City | FORT MYERS
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State | FL
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Zip | 33919-4893
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Country | US
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Telephone | 717-395-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 8931 CONFERENCE DR
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City | FORT MYERS
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State | FL
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Zip | 33919-4893
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN JAMES SNYDER
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Credential | M.S.
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Telephone | 717-395-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH14711
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9106
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11298
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME60410
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License Number State | FL
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