Provider Demographics
NPI:1790525145
Name:SHARDAE TRIPP COUNSELING LLC
Entity type:Organization
Organization Name:SHARDAE TRIPP COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARDAE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-418-7797
Mailing Address - Street 1:1860 SW FOUNTAINVIEW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4528
Mailing Address - Country:US
Mailing Address - Phone:772-418-7797
Mailing Address - Fax:
Practice Address - Street 1:5590 NW PINE TRAIL CIRCLE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-418-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty