Provider Demographics
NPI:1174906309
Name:BAYLIFE COUNSELING, LLC
Entity type:Organization
Organization Name:BAYLIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:727-741-0704
Mailing Address - Street 1:6611 US HIGHWAY 19
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-1732
Mailing Address - Country:US
Mailing Address - Phone:727-741-0704
Mailing Address - Fax:888-972-7961
Practice Address - Street 1:6611 US HIGHWAY 19
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1732
Practice Address - Country:US
Practice Address - Phone:727-741-0704
Practice Address - Fax:888-972-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty