=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578327417
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAOLA AMADA BALSECA RMHCI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2024
-----------------------------------------------------
Last Update Date | 02/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17410 SR 50 STE 130
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-8188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-500-7176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 756 WALKERS GROVE LN
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-2723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-710-8262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 23804
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------