Healthcare Provider Details

I. General information

NPI: 1205782760
Provider Name (Legal Business Name): ANDREA MONGELLUZZI LPC.0023535
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N NEVADA AVE
COLORADO SPRINGS CO
80907-7431
US

IV. Provider business mailing address

2842 LONG VIEW DR
CLEARWATER FL
33761-3200
US

V. Phone/Fax

Practice location:
  • Phone: 727-772-3308
  • Fax:
Mailing address:
  • Phone: 727-772-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0023535
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: