Provider Demographics
NPI:1992581649
Name:FLORIDA BAPTIST CHILDREN'S HOMES
Entity type:Organization
Organization Name:FLORIDA BAPTIST CHILDREN'S HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCC, LMHC
Authorized Official - Phone:352-978-2988
Mailing Address - Street 1:1015 SIKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4499
Mailing Address - Country:US
Mailing Address - Phone:352-978-2988
Mailing Address - Fax:
Practice Address - Street 1:1015 SIKES BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4499
Practice Address - Country:US
Practice Address - Phone:352-978-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty