Healthcare Provider Details

I. General information

NPI: 1720904113
Provider Name (Legal Business Name): CLAIRE RYDER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 N HABANA AVE STE 302
TAMPA FL
33614-7183
US

IV. Provider business mailing address

4728 N HABANA AVE STE 302
TAMPA FL
33614-7183
US

V. Phone/Fax

Practice location:
  • Phone: 262-366-8764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: