MEDICARE: MRS. MAUREEN TRAVERS HARPER 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	10304	FL

General Provider Information

NPI Number	:	1588983480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN TRAVERS HARPER LMHC

Provider Business Mailing Address
First Line	:	4400 MARSH LANDING BLVD STE 6
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1287
Country	:	US
Telephone Number	:	904-280-3324
Fax Number	:	904-280-3372

Provider Business Practice Location Address
First Line	:	4400 MARSH LANDING BLVD STE 6
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1287
Country	:	US
Telephone Number	:	904-280-3324
Fax Number	:	904-280-3372

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

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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