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General NPI Number Information
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NPI Number | 1518394618
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Entity Type | Organization
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Legal Business Name | MIKE DEASE, LMHC, CAP, LLC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 1106 THOMASVILLE RD STE F
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6587
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Country | US
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Telephone | 850-577-1555
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Fax | 850-577-1556
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Provider Business Mailing Address
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Address Line | 1106 THOMASVILLE RD STE F
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6587
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Country | US
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Telephone | 850-577-1555
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Fax | 850-577-1556
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | JAMES M. DEASE
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Credential | LMHC, CAP
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Telephone | 850-577-1555
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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 | MH 11756
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License Number State | FL
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