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General NPI Number Information
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NPI Number | 1932656329
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Entity Type | Organization
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Legal Business Name | TAMPA BAY CLINICAL COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 408 W RENFRO ST STE 107F
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City | PLANT CITY
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State | FL
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Zip | 33563-5298
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Country | US
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Telephone | 813-734-5672
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Fax |
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Provider Business Mailing Address
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Address Line | 408 W RENFRO ST STE 107F
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City | PLANT CITY
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State | FL
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Zip | 33563-5298
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Country | US
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Telephone | 813-734-5672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL M LAATSCH
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Credential | LMHC
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Telephone | 813-734-5672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 768543
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 13522
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License Number State | FL
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