Basic Information
Provider Information
NPI: 1508392226
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PINDER
FirstName: CARRLEE
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 99198 OVERSEAS HWY STE 3
Address2:  
City: KEY LARGO
State: FL
PostalCode: 330372437
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 99198 OVERSEAS HWY STE 3
Address2:  
City: KEY LARGO
State: FL
PostalCode: 330372437
CountryCode: US
TelephoneNumber: 3054347660
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/02/2017
LastUpdateDate: 05/02/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XIMH15360FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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