Basic Information
| Provider Information | |||||||||
| NPI: | 1669866521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANK | ||||||||
| FirstName: | HEDRICK | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11562 MEADOWRUN CIR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339139064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347071090 | ||||||||
| FaxNumber: | 9413477702 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W MARION AVE UNIT 1209 | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339504466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413478341 | ||||||||
| FaxNumber: | 9413477702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3222 | AL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | MH17434 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 105064100 | 05 | FL | MEDICAID |