Healthcare Provider Details

I. General information

NPI: 1265343461
Provider Name (Legal Business Name): AZIMUTH EMDR/EMI TRAUMA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 7TH ST
CAPE CORAL FL
33993-1801
US

IV. Provider business mailing address

7901 4TH ST N
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 614-887-7770
  • Fax:
Mailing address:
  • Phone: 614-887-7770
  • 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: STACIE ANN MARIE PATTON
Title or Position: THERAPIST OWNER
Credential: LMHC
Phone: 614-887-7770