Healthcare Provider Details

I. General information

NPI: 1063624765
Provider Name (Legal Business Name): YVETTE ADDEASE MONTSHO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 3RD AVE S
SAINT PETERSBURG FL
33707-1808
US

IV. Provider business mailing address

5210 3RD AVE S
SAINT PETERSBURG FL
33707-1808
US

V. Phone/Fax

Practice location:
  • Phone: 727-631-1581
  • Fax:
Mailing address:
  • Phone: 727-631-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011281
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: