Healthcare Provider Details

I. General information

NPI: 1942082847
Provider Name (Legal Business Name): LINDSAY A ENSELL MS, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 HUNTERS POND DR
TAMPA FL
33647-2560
US

IV. Provider business mailing address

9413 HUNTERS POND DR
TAMPA FL
33647-2560
US

V. Phone/Fax

Practice location:
  • Phone: 731-234-7191
  • Fax:
Mailing address:
  • Phone: 731-234-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH19920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: