=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639803760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRIVE MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2022
-----------------------------------------------------
Last Update Date | 06/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2440 N ESSEX AVE
-----------------------------------------------------
City | CITRUS HILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34442-5320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-558-8054
-----------------------------------------------------
Fax | 352-218-8485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4529 W SANCTION RD
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461-7623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-558-8054
-----------------------------------------------------
Fax | 352-218-8485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | THOMAS BUSTETTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-207-9681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------