Provider Demographics
NPI:1104540038
Name:SYCAMORE SHADE COUNSELING AND CONSULTATION LLC
Entity type:Organization
Organization Name:SYCAMORE SHADE COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARI
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-300-6171
Mailing Address - Street 1:5290 SUMMERLIN COMMONS WAY STE 1002
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2162
Mailing Address - Country:US
Mailing Address - Phone:321-300-6171
Mailing Address - Fax:
Practice Address - Street 1:5290 SUMMERLIN COMMONS WAY STE 1002
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2162
Practice Address - Country:US
Practice Address - Phone:321-300-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health