Healthcare Provider Details

I. General information

NPI: 1720362544
Provider Name (Legal Business Name): SARA L GEDAJLOVIC LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SNELL ISLE BLVD NE
SAINT PETERSBURG FL
33704-3830
US

IV. Provider business mailing address

930 SNELL ISLE BLVD NE
SAINT PETERSBURG FL
33704-3830
US

V. Phone/Fax

Practice location:
  • Phone: 727-743-3483
  • Fax: 727-896-7272
Mailing address:
  • Phone: 727-743-3483
  • Fax: 727-896-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 3061
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 3061
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH 3061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: