Healthcare Provider Details

I. General information

NPI: 1174111843
Provider Name (Legal Business Name): NIGEL G POULTON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11541 IVY FLOWER LOOP
RIVERVIEW FL
33578-9476
US

IV. Provider business mailing address

5510 N HESPERIDES ST
TAMPA FL
33614-5414
US

V. Phone/Fax

Practice location:
  • Phone: 813-503-4918
  • Fax:
Mailing address:
  • Phone: 813-467-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61629335
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: