Provider Demographics
NPI:1154776110
Name:GROVELAND FAMILY & CRISIS COUNSELING
Entity type:Organization
Organization Name:GROVELAND FAMILY & CRISIS COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WM
Authorized Official - Last Name:NUSSBAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-267-0519
Mailing Address - Street 1:611 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-2731
Mailing Address - Country:US
Mailing Address - Phone:352-429-5600
Mailing Address - Fax:352-429-1206
Practice Address - Street 1:611 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2731
Practice Address - Country:US
Practice Address - Phone:352-429-5600
Practice Address - Fax:352-429-1206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARVEST BAPTIST CHURCH OF ORLANDO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCPY0003010493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty