Provider Demographics
NPI:1699388744
Name:R.E.S.E.T. COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:R.E.S.E.T. COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIJUAN
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:201-503-5642
Mailing Address - Street 1:1806 E HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3543
Mailing Address - Country:US
Mailing Address - Phone:201-503-5642
Mailing Address - Fax:
Practice Address - Street 1:1806 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3543
Practice Address - Country:US
Practice Address - Phone:201-503-5642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health