Provider Demographics
NPI:1154323798
Name:TEIXEIRA, MILTON JAMES (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:JAMES
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 EHRLICH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2378
Mailing Address - Country:US
Mailing Address - Phone:813-908-2228
Mailing Address - Fax:813-908-5551
Practice Address - Street 1:3802 EHRLICH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2378
Practice Address - Country:US
Practice Address - Phone:813-908-2228
Practice Address - Fax:813-908-5551
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075250900Medicaid