Healthcare Provider Details

I. General information

NPI: 1417474735
Provider Name (Legal Business Name): MARIE L FAHRINGER, MA, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MILLENNIUM PKWY STE 1016
BRANDON FL
33511-4558
US

IV. Provider business mailing address

1210 MILLENNIUM CENTER SUITE 1016
BRANDON FL
33511-4896
US

V. Phone/Fax

Practice location:
  • Phone: 813-494-0656
  • Fax: 813-677-3060
Mailing address:
  • Phone: 813-494-0656
  • Fax: 813-677-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH13259
License Number StateFL

VIII. Authorized Official

Name: MRS. MARIE LUCILLE FAHRINGER
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MA, LMHC
Phone: 813-494-0656