MEDICARE: TAMPA LIFE COUNSELING, LLC

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)	14637	FL

General Provider Information

NPI Number	:	1487165254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA LIFE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	16209 MUIRFIELD DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13035 W LINEBAUGH AVE STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4481
Country	:	US
Telephone Number	:	813-906-8852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HA ALBERTI
Credential	:	LCSW
Telephone Number	:	817-271-7780

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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