Provider Demographics
NPI:1053927319
Name:PSYCHOLOGY OF ORIGINAL LOVE COUNSELING, LLC.
Entity type:Organization
Organization Name:PSYCHOLOGY OF ORIGINAL LOVE COUNSELING, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:321-234-3000
Mailing Address - Street 1:10800 MCCULLOCH RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3275
Mailing Address - Country:US
Mailing Address - Phone:321-234-3000
Mailing Address - Fax:321-400-1448
Practice Address - Street 1:599 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4943
Practice Address - Country:US
Practice Address - Phone:321-234-3000
Practice Address - Fax:321-400-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)