MEDICARE: EMILY B RIEGEL, LMHC PA

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	MH3390	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z6701	OTHER	FL	BLUE CROSS BLUE SHIELD FLORIDA

General Provider Information

NPI Number	:	1205247780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY B RIEGEL, LMHC PA

Provider Business Mailing Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	UNIT 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-564-2232
Fax Number	:

Provider Business Practice Location Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	UNIT 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-564-2232
Fax Number	:

Authorized Official
Title or Position	:	LMHC
Name	:	MS. EMILY RIEGEL
Credential	:	LMHC
Telephone Number	:	904-564-2232

Provider Enumeration Date	:	05/18/2014
Last Update Date	:	05/18/2014

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