Healthcare Provider Details

I. General information

NPI: 1861264798
Provider Name (Legal Business Name): HOLLI GOTSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 OAKFIELD DR
BRANDON FL
33511-0827
US

IV. Provider business mailing address

1018 CARRIAGE PARK DR
VALRICO FL
33594-4655
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-6367
  • Fax:
Mailing address:
  • Phone: 813-495-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: