Provider Demographics
NPI:1265973382
Name:CITRUS COUNTY COUNSELING
Entity type:Organization
Organization Name:CITRUS COUNTY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BASCOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, MCAP
Authorized Official - Phone:352-623-3163
Mailing Address - Street 1:4882 W PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2860
Mailing Address - Country:US
Mailing Address - Phone:352-423-3163
Mailing Address - Fax:
Practice Address - Street 1:4882 W PHOENIX DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-2860
Practice Address - Country:US
Practice Address - Phone:352-423-3163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW127831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty