Healthcare Provider Details

I. General information

NPI: 1750685947
Provider Name (Legal Business Name): BERNABE GONZALEZ-CRESPO LMHC, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2011
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MEDICAL CENTER AVE
SEBRING FL
33870-5423
US

IV. Provider business mailing address

2614 N LACONA RD
AVON PARK FL
33825-8555
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-9280
  • Fax:
Mailing address:
  • Phone: 863-703-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: