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General NPI Number Information
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NPI Number | 1801583646
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Entity Type | Organization
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Legal Business Name | SHARDAE TRIPP COUNSELING LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 540 NW UNIVERSITY BLVD STE 202
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2280
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Country | US
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Telephone | 772-418-7797
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Fax | 772-258-4480
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Provider Business Mailing Address
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Address Line | 540 NW UNIVERSITY BLVD STE 202
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2280
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Country | US
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Telephone | 772-418-7797
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Fax | 772-258-4480
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Authorized Official
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Title or Position | OWNER
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Name | SHARDAE TRIPP
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Credential | LMHC
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Telephone | 772-418-7797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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