# MODERN LIFE COUNSELING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790334407
- **Authorized official:** LISA SULLIVAN (OWNER)
- **Authorized official phone:** (813) 376-9700

## Contact information

- **Practice address:** 13902 N DALE MABRY HWY, SUITE 240, TAMPA, FL 33618-2428
- **Practice address phone:** (813) 376-9700
- **Practice address fax:** (813) 936-3585
- **Mailing address:** 13902 N DALE MABRY HWY, SUITE 230, TAMPA, FL 33618-2428
- **Mailing address phone:** (813) 376-9700
- **Mailing address fax:** (813) 936-3585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/05/2019
- **Last updated:** 09/05/2019