Healthcare Provider Details

I. General information

NPI: 1053430041
Provider Name (Legal Business Name): BETTY E SLAVNEY L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W KENNEDY BLVD SUITE 106
TAMPA FL
33609-2976
US

IV. Provider business mailing address

705 RICHARDS AVE
CLEARWATER FL
33755-5438
US

V. Phone/Fax

Practice location:
  • Phone: 813-354-9444
  • Fax: 813-954-9436
Mailing address:
  • Phone: 727-446-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: