Healthcare Provider Details

I. General information

NPI: 1851173199
Provider Name (Legal Business Name): MY TRIBE COUNSELING AND COACHING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 RIVER RD STE 207
NEW PORT RICHEY FL
34652-3756
US

IV. Provider business mailing address

5510 RIVER RD STE 207
NEW PORT RICHEY FL
34652-3756
US

V. Phone/Fax

Practice location:
  • Phone: 813-510-0572
  • Fax:
Mailing address:
  • Phone: 813-510-0572
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA CHANELLE MCPHATTER
Title or Position: PRACTITIONER
Credential: LMHC
Phone: 813-510-0572