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General NPI Number Information
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NPI Number | 1487023669
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Entity Type | Organization
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Legal Business Name | MANATEE COUNSELING GROUP LLC
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 1284 LORI DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4561
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Country | US
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Telephone | 260-409-9845
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Fax |
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Provider Business Mailing Address
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Address Line | 6349 EVARO AVE
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City | SPRING HILL
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State | FL
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Zip | 34608-1015
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Country | US
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Telephone | 260-409-9845
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICIAN
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Name | ANAH D EMERSON-TAYLOR
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Credential | LCSW PHD
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Telephone | 260-409-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12398
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License Number State | FL
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