Provider Demographics
NPI:1750649836
Name:ATALIA FOGEL LMHC, PC, LLC
Entity Type:Organization
Organization Name:ATALIA FOGEL LMHC, PC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, PC
Authorized Official - Phone:813-400-0419
Mailing Address - Street 1:449 MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3821
Mailing Address - Country:US
Mailing Address - Phone:813-400-0419
Mailing Address - Fax:813-333-5994
Practice Address - Street 1:18958 N DALE MABRY HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4911
Practice Address - Country:US
Practice Address - Phone:813-400-0419
Practice Address - Fax:813-333-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty