MEDICARE: EMPATH COUNSELING AND COACHING, PLCC

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	251S00000X	Community/Behavioral Health Agency	MH5396	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326535592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPATH COUNSELING AND COACHING, PLCC

Provider Business Mailing Address
First Line	:	18865 STATE ROAD 54
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-8201
Country	:	US
Telephone Number	:	813-436-3400
Fax Number	:	813-436-3400

Provider Business Practice Location Address
First Line	:	6936 W LINEBAUGH AVE STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5829
Country	:	US
Telephone Number	:	813-830-6900
Fax Number	:	813-436-3400

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	GEMMA MARIE CUOMO KAY
Credential	:	LMHC
Telephone Number	:	813-436-3400

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	05/11/2018

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