MEDICARE: THE PALMETTO PATH, LLC

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	:	1497603930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PALMETTO PATH, LLC

Provider Business Mailing Address
First Line	:	908 N COLLINS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-2440
Country	:	US
Telephone Number	:	813-843-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 N COLLINS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-2440
Country	:	US
Telephone Number	:	813-843-6128
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PROVIDER
Name	:	AUTUMN STANLEY
Credential	:	LMHC
Telephone Number	:	813-843-6128

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “THE PALMETTO PATH, LLC ” Practice Location

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