Healthcare Provider Details

I. General information

NPI: 1770910226
Provider Name (Legal Business Name): MELISSA EUTENEUER, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 COMMERCIAL WAY
SPRING HILL FL
34606-1110
US

IV. Provider business mailing address

5327 COMMERCIAL WAY SUITE C-115
SPRING HILL FL
34606-1448
US

V. Phone/Fax

Practice location:
  • Phone: 813-406-1311
  • Fax: 352-597-1662
Mailing address:
  • Phone: 352-597-5497
  • Fax: 352-597-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 10669
License Number StateFL

VIII. Authorized Official

Name: MELISSA EUTENEUER
Title or Position: THERAPIST
Credential: LCSW
Phone: 813-406-1311