MEDICARE: LASHELIA ANN STANCIL RMFTI

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1427687581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHELIA ANN STANCIL RMFTI

Provider Business Mailing Address
First Line	:	1020 S SCENIC HWY
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4824
Country	:	US
Telephone Number	:	863-978-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-6308
Country	:	US
Telephone Number	:	863-210-9473
Fax Number	:

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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