=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386515534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIL FERNANDEZ, LMHC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2025
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14445 7TH ST
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33523-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-553-9150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12410 FORT KING RD
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-315-1512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | GILBERTO FERNANDEZ
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 786-315-1512
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------