Healthcare Provider Details

I. General information

NPI: 1770579351
Provider Name (Legal Business Name): ARLENE K STORY MS LMHC TEP CHDAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14835 SE 85TH ST
OCKLAWAHA FL
32179-3556
US

IV. Provider business mailing address

14835 SE 85TH ST
OCKLAWAHA FL
32179-3556
US

V. Phone/Fax

Practice location:
  • Phone: 866-473-3843
  • Fax: 352-288-3343
Mailing address:
  • Phone: 866-473-3864
  • Fax: 352-288-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001215A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: