| Shardae Tripp Counseling, Llc | |
|
5590 Nw Pine Trail Cir Port Saint Lucie FL 34983-5349 | |
| (772) 418-7797 | |
| Not Available |
| Full Name | Shardae Tripp Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5590 Nw Pine Trail Cir, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Shardae Tripp (OWNER) |
| Authorized Official Contact | 7724187797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shardae Tripp Counseling, Llc 5590 Nw Pine Trail Cir Port Saint Lucie FL 34983-5349 Ph: (772) 418-7797 | Shardae Tripp Counseling, Llc 5590 Nw Pine Trail Cir Port Saint Lucie FL 34983-5349 Ph: (772) 418-7797 |
| NPI Number | 1801583646 |
|---|---|
| Provider Enumeration Date | 04/21/2023 |
| Last Update Date | 08/30/2023 |
| Certification Date | 08/30/2023 |
| Medicare PECOS PAC ID | 5496101784 |
|---|---|
| Medicare Enrollment ID | O20231023002182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801583646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Christine Barbato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124647789 PECOS PAC ID: 0143605717 Enrollment ID: I20220917000473 |
| Provider Name | Tatiana Jean-winder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396092839 PECOS PAC ID: 5597110726 Enrollment ID: I20231009001288 |
| Provider Name | Latonya Denise Shaw |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033419361 PECOS PAC ID: 6002265345 Enrollment ID: I20231212000788 |
| Provider Name | Shardae C Tripp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700310513 PECOS PAC ID: 8022464312 Enrollment ID: I20231212004240 |
| Provider Name | Keianna Simon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457042079 PECOS PAC ID: 1951750025 Enrollment ID: I20231214001885 |
| Provider Name | Stacy Anne Kidwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114573912 PECOS PAC ID: 7113360165 Enrollment ID: I20240207001749 |
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