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General NPI Number Information
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NPI Number | 1710942347
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Entity Type | Organization
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Legal Business Name | SOUTHEAST PSYCHOLOGICAL CONSULTING, LLC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 4723B NW 53RD AVE, SUITE B SOUTHEAST PSYCHOLOGICAL CONSULTING LLC
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City | GAINESVILLE
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State | FL
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Zip | 32653
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Country | US
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Telephone | 352-338-0077
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Fax | 352-372-6910
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Provider Business Mailing Address
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Address Line | 5200 NW 43RD ST., SUITE 102 #254 SOUTHEAST PSYCHOLOGICAL CONSULTING LLC
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City | GAINESVILLE
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State | FL
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Zip | 32606-4486
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Country | US
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Telephone | 352-338-0077
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Fax | 352-372-6910
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Authorized Official
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Title or Position | PHD LICENSED PSYCHOLOGIST/OWNER
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Name | DR. HELEN ELIZABETH CADIZ
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Credential | PH.D, PSYCHOLOGIST
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Telephone | 352-338-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | PY5139
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY5139
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License Number State | FL
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