Provider Demographics
NPI:1710362397
Name:ANGIE SPELLER, LMHC, PA
Entity type:Organization
Organization Name:ANGIE SPELLER, LMHC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-386-6495
Mailing Address - Street 1:4613 W NORTH A ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1909
Mailing Address - Country:US
Mailing Address - Phone:727-386-6495
Mailing Address - Fax:
Practice Address - Street 1:4613 W NORTH A ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1909
Practice Address - Country:US
Practice Address - Phone:727-386-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106H00000X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty