Provider Demographics
NPI:1619213832
Name:LOVING LIFE THERAPY
Entity Type:Organization
Organization Name:LOVING LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DE RIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:813-609-6946
Mailing Address - Street 1:300 E MADISON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4813
Mailing Address - Country:US
Mailing Address - Phone:813-609-6946
Mailing Address - Fax:813-609-6946
Practice Address - Street 1:300 E MADISON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4813
Practice Address - Country:US
Practice Address - Phone:813-609-6946
Practice Address - Fax:813-609-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT-1814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty