Provider Demographics
NPI:1467593723
Name:MORT, DAWN M (MS)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MORT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:MANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, LCAC
Mailing Address - Street 1:9176 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-6207
Mailing Address - Country:US
Mailing Address - Phone:352-422-3711
Mailing Address - Fax:352-623-5463
Practice Address - Street 1:10489 HELEY ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3729
Practice Address - Country:US
Practice Address - Phone:352-422-3711
Practice Address - Fax:352-623-5463
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000117A101YA0400X
FLMH16045101YM0800X
IN39002221A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467593723OtherNPI