MEDICARE: HOPE PSYCHOTHERAPY & CONSULTING SERVICES 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	1041C0700X	Clinical Social Worker	SW13900	FL

General Provider Information

NPI Number	:	1972013290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE PSYCHOTHERAPY & CONSULTING SERVICES LLC

Provider Business Mailing Address
First Line	:	20112 SATIN LEAF AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3717
Country	:	US
Telephone Number	:	917-295-3539
Fax Number	:	813-443-3172

Provider Business Practice Location Address
First Line	:	2604 CYPRESS RIDGE BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6311
Country	:	US
Telephone Number	:	813-517-6089
Fax Number	:	813-443-3172

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/CONSULTANT/OWNER
Name	:	RUBY TORRES
Credential	:	LCSW
Telephone Number	:	813-517-6089

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	02/18/2019

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