MEDICARE: DEIDRE MCLEOD 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	MH12267	FL

General Provider Information

NPI Number	:	1376860759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRE MCLEOD LMHC

Provider Business Mailing Address
First Line	:	2140 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3740
Country	:	US
Telephone Number	:	863-291-5560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3740
Country	:	US
Telephone Number	:	866-280-9355
Fax Number	:

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	11/23/2020

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