1902449689 NPI number — MANATEE ASSOCIATES OF COUNSELING & ASSESSMENT

Table of content: MIRANDA MASHALLE GALLEGOS A.A. (NPI 1841931763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902449689 NPI number — MANATEE ASSOCIATES OF COUNSELING & ASSESSMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANATEE ASSOCIATES OF COUNSELING & ASSESSMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902449689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221-5044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-479-7866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34221-5044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-479-7866
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DIXON
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
SHALENE
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
941-479-7866

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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