=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851993596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALLAHASSEE COUNSELING & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2020
-----------------------------------------------------
Last Update Date | 03/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2354 CHRISTOPHER PL
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-510-8778
-----------------------------------------------------
Fax | 850-668-8047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2354 CHRISTOPHER PL
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-510-8778
-----------------------------------------------------
Fax | 850-668-8047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AUSTYN VAN DER LINDEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 850-510-8778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------