MEDICARE: KAREN GABRIEL

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

General Provider Information

NPI Number	:	1447621560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN GABRIEL

Provider Business Mailing Address
First Line	:	4300 MARSH LANDING BLVD STE 204
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1420
Country	:	US
Telephone Number	:	904-583-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 MARSH LANDING BLVD STE 204
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1420
Country	:	US
Telephone Number	:	904-583-4366
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	DONNA MOSELEY
Credential	:
Telephone Number	:	904-583-4366

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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