MEDICARE: COHERENT MIND P.A.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1306792551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHERENT MIND P.A.

Provider Business Mailing Address
First Line	:	123 W HOLLYWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W HOLLYWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4041
Country	:	US
Telephone Number	:	850-363-7161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SAMUEL ROBERT MYRICK
Credential	:	LCSW
Telephone Number	:	850-363-7161

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “COHERENT MIND P.A. ” Practice Location

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