Provider Demographics
NPI:1811373780
Name:DEBORAH A CLEMENTS LMHC PA
Entity Type:Organization
Organization Name:DEBORAH A CLEMENTS LMHC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-625-6055
Mailing Address - Street 1:PO BOX 76423
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33734-6423
Mailing Address - Country:US
Mailing Address - Phone:813-625-6055
Mailing Address - Fax:727-823-8082
Practice Address - Street 1:275 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3205
Practice Address - Country:US
Practice Address - Phone:813-625-6055
Practice Address - Fax:727-823-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10350251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592092717Medicaid