Provider Demographics
NPI:1306268339
Name:RITZ, THERESA ANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:RITZ
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 1:1260 S MARTIN LUTHER KING JR AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4172
Mailing Address - Country:US
Mailing Address - Phone:727-504-3505
Mailing Address - Fax:888-965-5135
Practice Address - Street 1:1260 S MARTIN LUTHER KING JR AVE STE D
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-504-3505
Practice Address - Fax:888-965-5135
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health