Provider Demographics
NPI:1083917207
Name:LLEWELLYN, DAVID R
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3218
Mailing Address - Country:US
Mailing Address - Phone:239-595-3022
Mailing Address - Fax:239-244-8404
Practice Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3218
Practice Address - Country:US
Practice Address - Phone:239-595-3022
Practice Address - Fax:239-244-8404
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health