Healthcare Provider Details

I. General information

NPI: 1649864158
Provider Name (Legal Business Name): TINA OGDEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 FAYETTEVILLE DR
SPRING HILL FL
34609-4929
US

IV. Provider business mailing address

1607 FAYETTEVILLE DR
SPRING HILL FL
34609-4929
US

V. Phone/Fax

Practice location:
  • Phone: 352-428-6619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: