MEDICARE: STEVEN ELLIOTT CLARKE NCC, RMHCI

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	IMH15752	FL

General Provider Information

NPI Number	:	1588121222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ELLIOTT CLARKE NCC, RMHCI

Provider Business Mailing Address
First Line	:	2180 W FIRST ST STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3217
Country	:	US
Telephone Number	:	239-318-9682
Fax Number	:	239-334-3660

Provider Business Practice Location Address
First Line	:	2180 W FIRST ST STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3217
Country	:	US
Telephone Number	:	239-318-9682
Fax Number	:	239-334-3660

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

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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