Healthcare Provider Details

I. General information

NPI: 1972936854
Provider Name (Legal Business Name): MARLYNN PATRAY PHARNES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 3RD ST SW STE 304
WINTER HAVEN FL
33880-2969
US

IV. Provider business mailing address

20 3RD ST SW STE 304
WINTER HAVEN FL
33880-2969
US

V. Phone/Fax

Practice location:
  • Phone: 863-224-2408
  • Fax:
Mailing address:
  • Phone: 863-224-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: