Healthcare Provider Details

I. General information

NPI: 1225750110
Provider Name (Legal Business Name): MENTAL WELLNESS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6497 PARKLAND DR
SARASOTA FL
34243-4097
US

IV. Provider business mailing address

11806 ACORN WOODS TER
LAKEWOOD RANCH FL
34202-2801
US

V. Phone/Fax

Practice location:
  • Phone: 941-212-2040
  • Fax:
Mailing address:
  • Phone: 941-212-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHPRESA KALETSCH
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 941-212-2040