Provider Demographics
NPI:1023102779
Name:VANGELDER, STEVEN C (LMHC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:VANGELDER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 VONDERBURG DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6072
Mailing Address - Country:US
Mailing Address - Phone:813-881-1000
Mailing Address - Fax:813-689-2856
Practice Address - Street 1:565 MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5001
Practice Address - Country:US
Practice Address - Phone:386-310-8766
Practice Address - Fax:386-310-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 3318103TA0400X
FLMH9157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767467800Medicaid