Healthcare Provider Details

I. General information

NPI: 1710362397
Provider Name (Legal Business Name): ANGIE SPELLER, LMHC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 W NORTH A ST
TAMPA FL
33609-1909
US

IV. Provider business mailing address

4613 W NORTH A ST
TAMPA FL
33609-1909
US

V. Phone/Fax

Practice location:
  • Phone: 727-386-6495
  • Fax:
Mailing address:
  • Phone: 727-386-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name: ANGIE SPELLER
Title or Position: OWNER
Credential: LMHC
Phone: 727-386-6495