MEDICARE: KRISTINA MATILDE DAWSON 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	MH17811	FL

General Provider Information

NPI Number	:	1083236780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MATILDE DAWSON LMHC

Provider Business Mailing Address
First Line	:	1515 N FLAGLER DR STE 800
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N FLAGLER DR STE 800
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3431
Country	:	US
Telephone Number	:	561-812-7060
Fax Number	:

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

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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