Statera Psychotherapy LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Lutz, FL. Organization (NPI-2).
NPI number1699403147
StatusActive
Last updated in NPPESAug 11, 2022
Details
- NPI
- 1699403147
- Entity type
- Organization (NPI-2)
- Legal business name
- Statera Psychotherapy LLC
- Organization subpart
- No
- Enumeration date
- Aug 11, 2022
- Certification date
- Aug 11, 2022
- Last updated
- Aug 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
19730 Morden Blush DrLutz, FL 33558-9088
Phone 813-438-6115 · Fax 813-296-2115
Mailing address
19730 Morden Blush DrLutz, FL 33558-9088
Phone 813-438-6115 · Fax 813-296-2115
Authorized official
Katalin Vinczi-Sierra
Member-Manager
8134386115
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