Healthcare Provider Details

I. General information

NPI: 1083173793
Provider Name (Legal Business Name): PETER LETENDRE, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N COLLIER BLVD
MARCO ISLAND FL
34145-2773
US

IV. Provider business mailing address

6786 BERWICK PL
NAPLES FL
34104-8311
US

V. Phone/Fax

Practice location:
  • Phone: 401-226-1119
  • Fax:
Mailing address:
  • Phone: 401-226-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PETER C LETENDRE
Title or Position: FOUNDER
Credential: LMHC
Phone: 401-226-1119