Healthcare Provider Details

I. General information

NPI: 1215636394
Provider Name (Legal Business Name): NEW LIFE PSYCHOLOGY AND COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W BEARSS AVE
TAMPA FL
33613-1228
US

IV. Provider business mailing address

322 W BEARSS AVE
TAMPA FL
33613-1228
US

V. Phone/Fax

Practice location:
  • Phone: 888-899-7736
  • Fax:
Mailing address:
  • Phone: 888-899-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELENA NEGRON-CHAVES
Title or Position: PRESIDENT
Credential: PHD
Phone: 888-899-7736