Healthcare Provider Details

I. General information

NPI: 1184077984
Provider Name (Legal Business Name): HEATHER DAWN ESLIEN MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 OAK ST
SARASOTA FL
34236-7517
US

IV. Provider business mailing address

1608 OAK ST
SARASOTA FL
34236-7517
US

V. Phone/Fax

Practice location:
  • Phone: 941-840-0878
  • Fax: 941-955-6269
Mailing address:
  • Phone: 941-840-0878
  • Fax: 941-955-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: