Healthcare Provider Details

I. General information

NPI: 1902135304
Provider Name (Legal Business Name): RITA ANN CHANEY M.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 CENTER RD
VENICE FL
34285-5572
US

IV. Provider business mailing address

3479 SHAWN ST
PORT CHARLOTTE FL
33980-8660
US

V. Phone/Fax

Practice location:
  • Phone: 941-408-8988
  • Fax: 941-408-8846
Mailing address:
  • Phone: 941-624-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: