Healthcare Provider Details

I. General information

NPI: 1821827627
Provider Name (Legal Business Name): SEAN BANCROFT MCLEAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUISIANA AVE STE C
SAINT CLOUD FL
34769-4116
US

IV. Provider business mailing address

8266 VIA VERONA
ORLANDO FL
32836-7700
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH21807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: