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NPI Code Detail

MEDICARE: ACHIEVE WELLNESS GROUP LLC

MEDICARE: ACHIEVE WELLNESS GROUP 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
1103TC0700XClinical PsychologistPY7601FL

General Provider Information

NPI Number : 1932353695
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACHIEVE WELLNESS GROUP LLC
Provider Business Mailing Address
First Line : 550 N REO ST STE 300
Second Line :
City : TAMPA
State : FL
Zip : 33609-1037
Country : US
Telephone Number : 813-261-5004
Fax Number : 813-261-5008
Provider Business Practice Location Address
First Line : 550 N REO ST STE 300
Second Line :
City : TAMPA
State : FL
Zip : 33609-1037
Country : US
Telephone Number : 813-261-5004
Fax Number : 813-261-5008
Authorized Official
Title or Position : PRESIDENT
Name : DR. LISA IANNELLI CORREA
Credential : PSYD MBA
Telephone Number : 813-261-5004
Provider Enumeration Date : 11/07/2008
Last Update Date : 02/12/2009

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Directions to “ACHIEVE WELLNESS GROUP LLC ” Practice Location

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