Healthcare Provider Details

I. General information

NPI: 1033962923
Provider Name (Legal Business Name): MOLLY L BINGHAM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY L BINGHAM MOLLY KINARD

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10823 BOYETTE RD
RIVERVIEW FL
33569-8012
US

IV. Provider business mailing address

5605 LARK MEADOW PL
LITHIA FL
33547-5835
US

V. Phone/Fax

Practice location:
  • Phone: 813-308-9825
  • Fax:
Mailing address:
  • Phone: 850-766-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: