Healthcare Provider Details

I. General information

NPI: 1154651206
Provider Name (Legal Business Name): MICHAEL T. OBREITER LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 N PINELLAS AVE
TARPON SPRINGS FL
34689-5780
US

IV. Provider business mailing address

1919 N PINELLAS AVE
TARPON SPRINGS FL
34689-5780
US

V. Phone/Fax

Practice location:
  • Phone: 277-547-5200
  • Fax: 727-940-6073
Mailing address:
  • Phone: 727-547-5200
  • Fax: 727-940-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1560
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: