MEDICARE: LOVING LIFE TODAY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		FL

General Provider Information

NPI Number	:	1023509270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING LIFE TODAY, INC

Provider Business Mailing Address
First Line	:	300 E MADISON ST STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4813
Country	:	US
Telephone Number	:	813-609-6946
Fax Number	:	813-609-6947

Provider Business Practice Location Address
First Line	:	300 E MADISON ST STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4813
Country	:	US
Telephone Number	:	813-609-6946
Fax Number	:	813-609-6947

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	DR. YVONKA DE RIDDER
Credential	:	LMFT,PHD
Telephone Number	:	813-609-6946

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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