MEDICARE: AMBER PRIVETT 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)

General Provider Information

NPI Number	:	1548942543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBER PRIVETT COUNSELING LLC

Provider Business Mailing Address
First Line	:	2117 W IDLEWILD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1037
Country	:	US
Telephone Number	:	813-658-8153
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 W IDLEWILD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1037
Country	:	US
Telephone Number	:	813-658-8153
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMBER PRIVETT
Credential	:
Telephone Number	:	813-658-8153

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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