=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932974946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL PLAYBOOK COUNSELING AND CONSULTING CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5405 DIPLOMAT CIR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-459-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30319 PLYMOUTH CREEK CIR
-----------------------------------------------------
City | SORRENTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32776-9407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-459-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOANNA HEDIN
-----------------------------------------------------
Credential | LISW-CP
-----------------------------------------------------
Telephone | 352-459-5019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------