Healthcare Provider Details

I. General information

NPI: 1669973640
Provider Name (Legal Business Name): TANYA DELANIE SAMUELS DR. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date: 11/15/2023
Reactivation Date: 08/27/2026

III. Provider practice location address

1043 SEMINOLE SKY DR
RUSKIN FL
33570-2024
US

IV. Provider business mailing address

1043 SEMINOLE SKY DR
RUSKIN FL
33570-2024
US

V. Phone/Fax

Practice location:
  • Phone: 813-944-7976
  • Fax:
Mailing address:
  • Phone: 813-944-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: