Provider Demographics
NPI:1174736995
Name:HYDE PARK COUNSELING CENTER
Entity type:Organization
Organization Name:HYDE PARK COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:FERN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-557-4123
Mailing Address - Street 1:207 W VERNE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2332
Mailing Address - Country:US
Mailing Address - Phone:813-258-4605
Mailing Address - Fax:813-258-4705
Practice Address - Street 1:207 W VERNE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2332
Practice Address - Country:US
Practice Address - Phone:813-258-4605
Practice Address - Fax:813-258-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1329AD475701101YA0400X, 324500000X
101YM0800X, 261QR0405X
FL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty