Healthcare Provider Details

I. General information

NPI: 1427952472
Provider Name (Legal Business Name): GINA CELCIS-CONCEPCION
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17880 N HWY 41
LUTZ FL
33549-4502
US

IV. Provider business mailing address

17880 N HWY 41
LUTZ FL
33549-4502
US

V. Phone/Fax

Practice location:
  • Phone: 813-568-6254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: