Provider Demographics
NPI:1013515162
Name:SKIFSTAD, TAMI J (LMHC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:SKIFSTAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31640 US HIGHWAY 19 N STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3738
Mailing Address - Country:US
Mailing Address - Phone:727-222-3595
Mailing Address - Fax:
Practice Address - Street 1:31640 US HIGHWAY 19 N STE 2
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3738
Practice Address - Country:US
Practice Address - Phone:727-222-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18442101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH18442OtherFLORIDA DEPARTMENT OF HEALTH