Provider Demographics
NPI:1962790121
Name:KLA COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:KLA COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:PARRIS
Authorized Official - Last Name:AGULIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:772-233-4282
Mailing Address - Street 1:4653 SW BERMUDA WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1220
Mailing Address - Country:US
Mailing Address - Phone:772-233-4282
Mailing Address - Fax:772-248-1358
Practice Address - Street 1:850 NW FEDERAL HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1019
Practice Address - Country:US
Practice Address - Phone:772-233-4282
Practice Address - Fax:772-248-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9214251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health