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General NPI Number Information
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NPI Number | 1326475708
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Entity Type | Organization
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Legal Business Name | LAKELAND COUNSELING LLC
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 3221 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33803-4550
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Country | US
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Telephone | 863-614-0034
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Fax | 863-937-0284
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Provider Business Mailing Address
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Address Line | PO BOX 91872
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City | LAKELAND
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State | FL
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Zip | 33804-1872
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Country | US
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Telephone | 863-614-0034
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Fax | 863-937-0284
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DONALD WILLETS
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Credential | LMHC
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Telephone | 863-614-0034
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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 | MH 2300
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License Number State | FL
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