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General NPI Number Information
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NPI Number | 1417474735
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Entity Type | Organization
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Legal Business Name | MARIE L FAHRINGER, MA, LMHC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1210 MILLENNIUM PKWY STE 1016
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City | BRANDON
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State | FL
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Zip | 33511-4558
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Country | US
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Telephone | 813-494-0656
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Fax | 813-677-3060
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Provider Business Mailing Address
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Address Line | 1210 MILLENNIUM CENTER SUITE 1016
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City | BRANDON
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State | FL
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Zip | 33511-4896
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Country | US
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Telephone | 813-494-0656
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Fax | 813-677-3060
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MRS. MARIE LUCILLE FAHRINGER
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Credential | MA, LMHC
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Telephone | 813-494-0656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH13259
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License Number State | FL
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