NPIMap

Organization Active NPI

Dandelion Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Charlotte, FL
National Provider Identifier
1053028787
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
DANDELION BEHAVIORAL HEALTH LLC
Practice address
1777 Tamiami TRL
Port Charlotte, FL 33948-1078
Phone
(941) 780-4268
NPI assigned
Nov 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tamara Tridle, LCSWNPI 1619612439
Title
Owner
Phone
(941) 780-4268

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1777 Tamiami TRL
Port Charlotte, FL 33948-1078

Mailing address

25443 Estrada Circle
Punta Gorda, FL 33955
Phone (402) 217-4555

Other practice location 1

3524 Tamiami Trl
Port Charlotte, FL 33952-8155
Phone (941) 780-4268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250307000590 FL Part B Supplier - Clinic/Group Practice 9739600685 Receives reassigned benefits from 15 practitioners
Practice locations: Fort Myers, FL; Port Charlotte, FL; Punta Gorda, FL; Titusville, FL

National Provider Directory

National Provider Directory

Locations

6213 Presidential Ct
Ste 100
Fort Myers, FL 33919

1777 Tamiami Trl
Ste 500
Port Charlotte, FL 33948
Phone (941) 391-6605

3380 S Park Ave
Ste 9
Titusville, FL 32780

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1053028787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25443 ESTRADA CIRCLE",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "33955",
            "telephone_number": "402-217-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481078",
            "telephone_number": "941-780-4268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3524 Tamiami Trl",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339528155",
            "country_code": "US",
            "telephone_number": "941-780-4268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DANDELION BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "TRIDLE",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-780-4268",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.