MEDICARE: MS. SHERIDON KATHRYN LEVENS 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	MH3682	FL

General Provider Information

NPI Number	:	1700802360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERIDON KATHRYN LEVENS LMHC

Provider Business Mailing Address
First Line	:	3308 S SAN MIGUEL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7033
Country	:	US
Telephone Number	:	813-230-6901
Fax Number	:	813-287-1721

Provider Business Practice Location Address
First Line	:	200 S HOOVER BLVD
Second Line	:	STE 170
City	:	TAMPA
State	:	FL
Zip	:	33609-3540
Country	:	US
Telephone Number	:	813-287-1636
Fax Number	:	813-287-1721

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/08/2007

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