Provider Demographics
NPI:1376957092
Name:PERHEALTH, TABATHA (LMHC)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:PERHEALTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 8TH AVE W STE 103
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5119
Mailing Address - Country:US
Mailing Address - Phone:941-304-2879
Mailing Address - Fax:
Practice Address - Street 1:433 8TH AVE W STE 103
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5119
Practice Address - Country:US
Practice Address - Phone:941-304-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2022-07-21
Deactivation Date:2018-08-31
Deactivation Code:
Reactivation Date:2018-09-17
Provider Licenses
StateLicense IDTaxonomies
FLMH15172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health