MEDICARE: TAMPA TRAUMA THERAPY

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

General Provider Information

NPI Number	:	1487414884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA TRAUMA THERAPY

Provider Business Mailing Address
First Line	:	15 8TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-3614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5009 N CENTRAL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2213
Country	:	US
Telephone Number	:	727-644-9414
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELANIE RYERSON
Credential	:	MA, LMHC
Telephone Number	:	727-644-9414

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	01/13/2025

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Directions to “TAMPA TRAUMA THERAPY ” Practice Location

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