MEDICARE: EMILY SARAH TRIPP LMHC, MA

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	MH19148	FL

General Provider Information

NPI Number	:	1407510266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SARAH TRIPP LMHC, MA

Provider Business Mailing Address
First Line	:	111 2ND AVE NE STE 640
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3455
Country	:	US
Telephone Number	:	727-344-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 2ND AVE NE STE 640
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3455
Country	:	US
Telephone Number	:	727-344-9867
Fax Number	:

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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