Healthcare Provider Details

I. General information

NPI: 1386563690
Provider Name (Legal Business Name): MOLLY BINGHAM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
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: 813-308-9825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MOLLY BINGHAM
Title or Position: OWNER
Credential: LMHC
Phone: 850-766-0946