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General NPI Number Information
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NPI Number | 1780259895
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Entity Type | Organization
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Legal Business Name | FACE IT PSYCHOTHERAPY
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 9105 SHADOW POND CT
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City | ODESSA
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State | FL
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Zip | 33556-3148
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Country | US
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Telephone | 813-297-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 9105 SHADOW POND CT
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City | ODESSA
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State | FL
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Zip | 33556-3148
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Country | US
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Telephone | 813-297-8331
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Fax |
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Authorized Official
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Title or Position | CLINICAL MENTAL HEALTH COUNSELOR
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Name | MRS. TERESA CARMEL MCKENNA
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Credential | LMHC
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Telephone | 813-297-8331
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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 |
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License Number State |
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