Provider Demographics
NPI:1962049387
Name:CATALYST COUNSELING ASSOCIATES LLC
Entity type:Organization
Organization Name:CATALYST COUNSELING ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-593-0122
Mailing Address - Street 1:4724 LAKE TRUDY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1668
Mailing Address - Country:US
Mailing Address - Phone:407-205-2597
Mailing Address - Fax:
Practice Address - Street 1:1320 LOUISIANA AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4116
Practice Address - Country:US
Practice Address - Phone:407-593-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101662900Medicaid