MEDICARE: GULF GROVE THERAPY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1104614155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF GROVE THERAPY

Provider Business Mailing Address
First Line	:	5009 N CENTRAL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2213
Country	:	US
Telephone Number	:	727-644-9414
Fax Number	:	727-644-9414

Provider Business Practice Location Address
First Line	:	5009 N CENTRAL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2213
Country	:	US
Telephone Number	:	727-644-9414
Fax Number	:	727-644-9414

Authorized Official
Title or Position	:	OWNER
Name	:	MELANIE RYERSON
Credential	:	LMHC
Telephone Number	:	727-644-9414

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “GULF GROVE THERAPY ” Practice Location

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