Healthcare Provider Details

I. General information

NPI: 1073074498
Provider Name (Legal Business Name): ESMA SIM YETISENER MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 FRUITVILLE RD # F-1
SARASOTA FL
34237-6410
US

IV. Provider business mailing address

3277 FRUITVILLE RD # F-1
SARASOTA FL
34237-6410
US

V. Phone/Fax

Practice location:
  • Phone: 941-312-6412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: