Healthcare Provider Details

I. General information

NPI: 1730991316
Provider Name (Legal Business Name): WONDERLEY CONSULTATION AND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 ALLEGRA WAY
LUTZ FL
33559-6998
US

IV. Provider business mailing address

2972 ALLEGRA WAY
LUTZ FL
33559-6998
US

V. Phone/Fax

Practice location:
  • Phone: 813-530-6429
  • Fax:
Mailing address:
  • Phone: 813-530-6429
  • 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: MARNI I WONDERLEY
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 813-530-6429