MEDICARE: MISTY BROOKE RUMMAGE 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	1041C0700X	Clinical Social Worker	MH15388	FL
2	101YM0800X	Mental Health Counselor	MH15388	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316456387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY BROOKE RUMMAGE LMHC

Provider Business Mailing Address
First Line	:	4740 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5839
Country	:	US
Telephone Number	:	954-486-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 NW PEACOCK BLVD STE 10
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2213
Country	:	US
Telephone Number	:	772-361-6767
Fax Number	:

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

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	09/14/2022

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