Provider Demographics
NPI:1366772048
Name:FACKELMAN, SARALEE HOPE (LMHC)
Entity type:Individual
Prefix:MS
First Name:SARALEE
Middle Name:HOPE
Last Name:FACKELMAN
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 1:1206 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4908
Mailing Address - Country:US
Mailing Address - Phone:813-662-4213
Mailing Address - Fax:813-620-4900
Practice Address - Street 1:1206 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4908
Practice Address - Country:US
Practice Address - Phone:813-662-4213
Practice Address - Fax:813-620-4900
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional