Provider Demographics
NPI:1932675782
Name:ETHERTON, DENISE R (LPC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:ETHERTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 FIRCREST CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-8167
Mailing Address - Country:US
Mailing Address - Phone:813-995-5365
Mailing Address - Fax:
Practice Address - Street 1:1733 FIRCREST CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8167
Practice Address - Country:US
Practice Address - Phone:813-995-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040391101YM0800X
FLTPMC1516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health