MEDICARE: MS. KAREN MICHEEL GABRIEL MED, 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	MH6579	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z040C	OTHER	FL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1235204926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN MICHEEL GABRIEL MED, LMHC

Provider Business Mailing Address
First Line	:	4300 MARSH LANDING BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1416
Country	:	US
Telephone Number	:	904-280-0471
Fax Number	:	904-273-1400

Provider Business Practice Location Address
First Line	:	4300 MARSH LANDING BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1416
Country	:	US
Telephone Number	:	904-280-0471
Fax Number	:	904-273-1400

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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