Provider Demographics
NPI:1992566889
Name:EMERALD SPRINGS FAMILY COUNSELING LLC
Entity type:Organization
Organization Name:EMERALD SPRINGS FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MARCOLONGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:719-286-3338
Mailing Address - Street 1:81 ST HWY 83 N STE A
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-7487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 ST HWY 83 N STE A
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7487
Practice Address - Country:US
Practice Address - Phone:719-286-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)