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General NPI Number Information
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NPI Number | 1245614999
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Entity Type | Individual
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Provider Name | CLAUDIA CARRILLO MH15788
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Gender | Female
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 4729 US 98 S STE 104
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City | LAKELAND
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State | FL
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Zip | 33812
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Country | US
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Telephone | 863-877-1855
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Fax | 863-646-6111
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Provider Business Mailing Address
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Address Line | 4729 US 98 S STE 104
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City | LAKELAND
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State | FL
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Zip | 33812-4323
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Country | US
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Telephone | 863-877-1855
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Fax | 863-646-6111
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15788
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License Number State | FL
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