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General NPI Number Information
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NPI Number | 1275121121
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Entity Type | Organization
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Legal Business Name | ESSENTIAL COUNSELING SERVICES
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 4421 NW 39TH AVE STE 3
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City | GAINESVILLE
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State | FL
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Zip | 32606-7221
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Country | US
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Telephone | 352-380-0209
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Fax | 352-380-0209
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Provider Business Mailing Address
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Address Line | 11647 NW 13TH LN
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City | GAINESVILLE
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State | FL
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Zip | 32606-0427
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Country | US
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Telephone | 352-318-7983
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MRS. TRACEY TOSKES KONOPKA
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Credential | LMHC
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Telephone | 352-318-7983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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