MEDICARE: TAISIR EL-SOUESSI 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	LCMHCS9032	NC
2	101YP2500X	Professional Counselor	LPC011393	GA
3	101YM0800X	Mental Health Counselor	MH17951	FL

General Provider Information

NPI Number	:	1215287529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAISIR EL-SOUESSI LMHC

Provider Business Mailing Address
First Line	:	1348 BEACH BLVD UNIT 51141
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32240-7749
Country	:	US
Telephone Number	:	904-595-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 SOUTHSIDE BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5458
Country	:	US
Telephone Number	:	904-595-7185
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	03/19/2026

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