Healthcare Provider Details

I. General information

NPI: 1497611420
Provider Name (Legal Business Name): IVELISSE COLON MARTINEZ RMHC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAKFIELD DR
BRANDON FL
33511-4938
US

IV. Provider business mailing address

621 SANDY CREEK DR
BRANDON FL
33511-7918
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-2644
  • Fax:
Mailing address:
  • Phone: 813-703-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: