Healthcare Provider Details

I. General information

NPI: 1417276437
Provider Name (Legal Business Name): HARRY SPEARS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SW 7TH TER
GAINESVILLE FL
32601-6459
US

IV. Provider business mailing address

225 SW 7TH TER
GAINESVILLE FL
32601-6459
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-2829
  • Fax: 352-379-2843
Mailing address:
  • Phone: 352-379-2829
  • Fax: 352-379-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101YP2500X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: