=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750649836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATALIA FOGEL LMHC, PC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18958 N DALE MABRY HWY SUITE 102
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33548-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-400-0419
-----------------------------------------------------
Fax | 813-333-5994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 MARMORA AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-3821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-400-0419
-----------------------------------------------------
Fax | 813-333-5994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/OWNER
-----------------------------------------------------
Name | MS. ATALIA FOGEL
-----------------------------------------------------
Credential | LMHC, PC
-----------------------------------------------------
Telephone | 813-400-0419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH8896
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------