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General NPI Number Information
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NPI Number | 1700034733
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Entity Type | Organization
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Legal Business Name | THE PARADIGM GROUP CONSULTING INC.
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 2523 US HIGHWAY 27 S SUITE 130
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City | AVON PARK
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State | FL
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Zip | 33825-7744
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Country | US
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Telephone | 863-991-5209
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Fax |
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Provider Business Mailing Address
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Address Line | 2523 US HIGHWAY 27 S SUITE 130
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City | AVON PARK
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State | FL
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Zip | 33825-7744
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Country | US
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Telephone | 863-991-5209
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP EDWARD VAN KLEECK
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Credential | MA, LMHC
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Telephone | 863-991-5209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MH9545
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License Number State | FL
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