MEDICARE: MRS. LOUISE GAY LMFT

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	MT1491	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT1491	OTHER	FL	LICENSED MARRIAGE & FAMIL

General Provider Information

NPI Number	:	1568424331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOUISE GAY LMFT

Provider Business Mailing Address
First Line	:	1545 HUFFINGHAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2721
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

Provider Business Practice Location Address
First Line	:	1545 HUFFINGHAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2721
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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