Organization
BLACK SWAN COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BERRY LMHC (MANAGING PARTNER)
(863) 667-8570
Entity
Organization
Contact information
Practice address
100 S KENTUCKY AVE STE 240, LAKELAND, FL 33801-5093
(863) 272-9137
Mailing address
100 S KENTUCKY AVE STE 240, LAKELAND, FL 33801-5093
(863) 272-9137
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
01/30/2025
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