Healthcare Provider Details

I. General information

NPI: 1255103941
Provider Name (Legal Business Name): EMBERLY NICOLE CAUSSEAUX MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 MAJOR BLVD STE 700
ORLANDO FL
32819-7973
US

IV. Provider business mailing address

5728 MAJOR BLVD STE 700
ORLANDO FL
32819-7973
US

V. Phone/Fax

Practice location:
  • Phone: 813-895-8278
  • Fax:
Mailing address:
  • Phone: 813-895-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: