Provider Demographics
NPI:1053534834
Name:PRATT, ROXANNE DAVIS (LPCC, LMHC, MPH)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:DAVIS
Last Name:PRATT
Suffix:
Gender:F
Credentials:LPCC, LMHC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 MERCHANT CT
Mailing Address - Street 2:SUITE L
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8437
Mailing Address - Country:US
Mailing Address - Phone:941-350-3009
Mailing Address - Fax:678-426-6620
Practice Address - Street 1:7313 MERCHANT CT
Practice Address - Street 2:SUITE L
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8437
Practice Address - Country:US
Practice Address - Phone:941-350-3009
Practice Address - Fax:678-426-6620
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003112101YP2500X
NM0125261101YP2500X
FLMH 13545101YP2500X
WALH 60421233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59988771Medicaid