The Health Coach, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW10256 Issued in FL

Legal business name

THE HEALTH COACH, LLC

Practice address

635 1St St N Ste C
Winter Haven, FL 33881-4129

Phone

(716) 861-0701

NPI assigned

May 26, 2018

Organization subpart

No

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

Authorized official

Name

Tanya M Jeckovich, LCSWNPI 1992913701

Title

MGR

Phone

(716) 861-0701

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanya M Jeckovich, LCSW

  • Clinical Social Worker
  • Winter Haven, FL
  • NPI 1992913701
  NPD (past) Authorized official

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

{
    "created_epoch": "1527292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1861983702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 21ST ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338813809",
            "telephone_number": "716-861-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 1ST ST N STE C",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814129",
            "telephone_number": "716-861-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HEALTH COACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-26",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "JECKOVICH",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "716-861-0701",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW10256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.