Healthcare Provider Details

I. General information

NPI: 1417705179
Provider Name (Legal Business Name): TYNE HURTADO LMHC NCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34125 US HIGHWAY 19 N STE 200
PALM HARBOR FL
34684-2115
US

IV. Provider business mailing address

34125 US HIGHWAY 19 N STE 200
PALM HARBOR FL
34684-2115
US

V. Phone/Fax

Practice location:
  • Phone: 727-487-1185
  • Fax:
Mailing address:
  • Phone: 727-487-1185
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TYNE HURTADO
Title or Position: LMHC/OWNER
Credential:
Phone: 727-487-1185