Healthcare Provider Details

I. General information

NPI: 1407415342
Provider Name (Legal Business Name): BETTY CARROL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKLEY SEAVER DR STE 213
CLERMONT FL
34711-1960
US

IV. Provider business mailing address

1200 OAKLEY SEAVER DR STE 213
CLERMONT FL
34711-1960
US

V. Phone/Fax

Practice location:
  • Phone: 863-323-7743
  • Fax:
Mailing address:
  • Phone: 904-802-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22557
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: