1487190302 NPI number — PATRICIA MUSSELWHITE-WEAVER, LMHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487190302 NPI number — PATRICIA MUSSELWHITE-WEAVER, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA MUSSELWHITE-WEAVER, LMHC
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:
6
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:
1487190302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7021C S TAMIAMI TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34231-5552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-922-6404
Provider Business Mailing Address Fax Number:
941-926-8724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7021C S TAMIAMI TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34231-5552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-922-6404
Provider Business Practice Location Address Fax Number:
941-926-8724
Provider Enumeration Date:
01/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MUSSELWHITE-WEAVER
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
941-922-6404

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH1969 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 768770200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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