Provider Demographics
NPI:1699551044
Name:ESSENTIAL CONNECTIONS THERAPY PLLC
Entity type:Organization
Organization Name:ESSENTIAL CONNECTIONS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIELDING-MADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LMHC, CRC
Authorized Official - Phone:813-509-4332
Mailing Address - Street 1:2780 E FOWLER AVE STE 428
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6297
Mailing Address - Country:US
Mailing Address - Phone:813-598-4332
Mailing Address - Fax:
Practice Address - Street 1:16120 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6129
Practice Address - Country:US
Practice Address - Phone:813-598-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)