MEDICARE: MICHAEL E WHALEN LMHC

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	:	1699441113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL E WHALEN LMHC

Provider Business Mailing Address
First Line	:	420 4TH ST S UNIT 408
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4627
Country	:	US
Telephone Number	:	727-742-8297
Fax Number	:	727-873-7860

Provider Business Practice Location Address
First Line	:	735 ARLINGTON AVE N STE 305
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3606
Country	:	US
Telephone Number	:	727-742-8297
Fax Number	:	727-873-7860

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL EDWARD WHALEN
Credential	:	LMHC
Telephone Number	:	727-742-8297

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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