Healthcare Provider Details

I. General information

NPI: 1619330065
Provider Name (Legal Business Name): TALK SEX WITH ME PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 TORCHWOOD DR
DELAND FL
32724-9467
US

IV. Provider business mailing address

739 TORCHWOOD DR
DELAND FL
32724-9467
US

V. Phone/Fax

Practice location:
  • Phone: 407-405-3257
  • Fax:
Mailing address:
  • Phone: 407-405-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TARA SPEARS
Title or Position: OWNER
Credential: LMHC, LMFT
Phone: 407-405-3257