K2 Psychological Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

K2 PSYCHOLOGICAL SERVICES, LLC

Practice address

541 S Orlando Ave Ste 306
Maitland, FL 32751-5669

Phone

(407) 810-2790

NPI assigned

Dec 29, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Bubalo

Title

MGR

Phone

(407) 810-2790

Specialties & licenses 1

Addresses

Other names 1

• K2 Pathways Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640736000000",
    "number": "1497415665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 S ORLANDO AVE STE 100",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515669",
            "telephone_number": "407-810-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 S ORLANDO AVE STE 306",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515669",
            "telephone_number": "407-810-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K2 PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-29",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "BUBALO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "407-810-2790"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matt.bubalo@k2med.com",
            "affiliation": "N",
            "endpointDescription": "secure email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "541 S Orlando Ave Ste 306",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327515669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "K2 Pathways",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Maitland, FL
• Providers in Maitland, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.