Healthcare Provider Details

I. General information

NPI: 1245899400
Provider Name (Legal Business Name): REBECCA CASKEY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MAIN AVE
MINNEOLA FL
34715-9578
US

IV. Provider business mailing address

600 S MAIN AVE
MINNEOLA FL
34715-9578
US

V. Phone/Fax

Practice location:
  • Phone: 352-464-1076
  • Fax:
Mailing address:
  • Phone: 352-464-1076
  • 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: REBECCA L CASKEY
Title or Position: THERAPIST
Credential: LMHC
Phone: 352-464-1076