MEDICARE: MR. ANTON PHILIP PUSTAVER M.ED./ED.S, LMHC

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

General Provider Information

NPI Number	:	1043519366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTON PHILIP PUSTAVER M.ED./ED.S, LMHC

Provider Business Mailing Address
First Line	:	411 BAYFRONT DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-8643
Country	:	US
Telephone Number	:	561-301-5787
Fax Number	:	352-374-5608

Provider Business Practice Location Address
First Line	:	411 BAYFRONT DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-8643
Country	:	US
Telephone Number	:	561-301-5787
Fax Number	:	352-374-5608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	08/07/2020

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