Individual
BEVERLY HILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
3309 21ST AVE W, BRADENTON, FL 34205-3015
(941) 313-5740
Mailing address
3309 21ST AVE W, BRADENTON, FL 34205-3015
(941) 313-5740
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q017979
—
TN
Enumeration date
02/24/2016
Last updated
02/24/2016
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