Provider Demographics
NPI:1639668692
Name:FENNELL, DARRELL WAYNE JR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:WAYNE
Last Name:FENNELL
Suffix:JR
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 1:8315 BERKELEY MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-6903
Mailing Address - Country:US
Mailing Address - Phone:813-557-7118
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR STE 2600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:813-557-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health