MEDICARE: DANIELLE EATON LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH 13249	FL
2	101YM0800X	Mental Health Counselor	15266	FL

General Provider Information

NPI Number	:	1285029165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE EATON LMHC

Provider Business Mailing Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:	813-239-8069
Fax Number	:	813-271-7324

Provider Business Practice Location Address
First Line	:	2212 E HENRY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4433
Country	:	US
Telephone Number	:	386-336-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	07/26/2017

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