Healthcare Provider Details

I. General information

NPI: 1396374948
Provider Name (Legal Business Name): MELANIE B STEBBINS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 4TH AVENUE CIR E
BRADENTON FL
34208-5621
US

IV. Provider business mailing address

PO BOX 197515
NASHVILLE TN
37219-7515
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax: 941-782-4101
Mailing address:
  • Phone: 941-782-4391
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: