=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528835212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METIME THERAPYCLOUD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2023
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 TAVESTOCK LOOP
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-463-4348
-----------------------------------------------------
Fax | 407-542-4866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 TAVESTOCK LOOP
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-463-4348
-----------------------------------------------------
Fax | 407-542-4866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | MRS. NADINE A. CLARKE
-----------------------------------------------------
Credential | LMHC, BCTMH, QCS
-----------------------------------------------------
Telephone | 407-463-4348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------