Healthcare Provider Details

I. General information

NPI: 1073056792
Provider Name (Legal Business Name): STEPHANIE NUNEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE MARTINEZ

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SW FOUNTAINVIEW BLVD STE 100
PORT SAINT LUCIE FL
34986-4528
US

IV. Provider business mailing address

1860 SW FOUNTAINVIEW BLVD
PORT SAINT LUCIE FL
34986-4535
US

V. Phone/Fax

Practice location:
  • Phone: 772-405-7419
  • Fax:
Mailing address:
  • Phone: 772-405-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM635-781-93-724-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: