MEDICARE: ALTERNATIVE DIRECTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 7519	FL

General Provider Information

NPI Number	:	1013057637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVE DIRECTIONS

Provider Business Mailing Address
First Line	:	1350 ORANGE AVE
Second Line	:	SUITE 296
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4945
Country	:	US
Telephone Number	:	407-579-6009
Fax Number	:	407-622-1200

Provider Business Practice Location Address
First Line	:	1350 N ORANGE AVE
Second Line	:	SUITE 296
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4945
Country	:	US
Telephone Number	:	407-579-6009
Fax Number	:	407-622-1200

Authorized Official
Title or Position	:	EXECUTIVE/CLINICAL DIRECTOR/OWNER
Name	:	MS. SHERRY STAPP MATTOS
Credential	:	LMHC
Telephone Number	:	407-579-6009

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/23/2008

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