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General NPI Number Information
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NPI Number | 1457892895
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Entity Type | Organization
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Legal Business Name | SMART LIVING COACHING SERVICES LLC
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 6050 34TH ST W APT 121
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City | BRADENTON
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State | FL
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Zip | 34210-3602
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Country | US
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Telephone | 480-323-9742
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2062
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City | SARASOTA
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State | FL
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Zip | 34230-2062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN WHITE
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Credential | PH.D.
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Telephone | 480-323-9742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY8659
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License Number State | FL
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