Healthcare Provider Details

I. General information

NPI: 1053802124
Provider Name (Legal Business Name): CARLOS E ESCOBAR LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14702 N FLORIDA AVE STE 103
TAMPA FL
33613-1822
US

IV. Provider business mailing address

14702 N FLORIDA AVE STE 103
TAMPA FL
33613-1822
US

V. Phone/Fax

Practice location:
  • Phone: 727-351-1978
  • Fax:
Mailing address:
  • Phone: 727-351-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH21661
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH21661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH21661
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: