Healthcare Provider Details

I. General information

NPI: 1093854929
Provider Name (Legal Business Name): GARY JAMES FARINAS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W WINDHORST RD
BRANDON FL
33510-2455
US

IV. Provider business mailing address

11229 GREAT NECK RD
RIVERVIEW FL
33578-4684
US

V. Phone/Fax

Practice location:
  • Phone: 813-401-2135
  • Fax:
Mailing address:
  • Phone: 813-401-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7397
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11023448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: