Provider Demographics
NPI:1548671274
Name:CATALYST COUNSELING LLC
Entity type:Organization
Organization Name:CATALYST COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MT-BC
Authorized Official - Phone:863-284-0817
Mailing Address - Street 1:308 E LEMON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5048
Mailing Address - Country:US
Mailing Address - Phone:863-284-0817
Mailing Address - Fax:863-284-0608
Practice Address - Street 1:308 E LEMON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5048
Practice Address - Country:US
Practice Address - Phone:863-284-0817
Practice Address - Fax:863-284-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000921800Medicaid