Healthcare Provider Details

I. General information

NPI: 1740538560
Provider Name (Legal Business Name): SUSAN ELIZABETH CASE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN PORTER

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 EVOLUTIONS WAY STE 102
TRINITY FL
34655-9900
US

IV. Provider business mailing address

7916 EVOLUTIONS WAY STE 102
TRINITY FL
34655-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-910-5990
  • Fax: 727-910-5992
Mailing address:
  • Phone: 727-910-5990
  • Fax: 727-910-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: