Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH11422 | FL |
NPI | 1003155003 |
---|---|
Provider Name | Ms. Mary Escudie |
First Address | Tampa, FL 33647-2199 |
Second Address | Brandon, FL 33510-4440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 11/02/2013 |