MEDICARE: MS. ANNETTE FIEDLER 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH6943	FL
2	101YM0800X	Mental Health Counselor	MH6943	FL
3	106H00000X	Marriage & Family Therapist	MH6943	FL
4	170300000X	Genetic Counselor (M.S.)	MH6943	FL

General Provider Information

NPI Number	:	1598832529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNETTE FIEDLER LMHC

Provider Business Mailing Address
First Line	:	22119 ELMIRA BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-7018
Country	:	US
Telephone Number	:	941-255-0616
Fax Number	:	941-295-7973

Provider Business Practice Location Address
First Line	:	22119 ELMIRA BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-7018
Country	:	US
Telephone Number	:	941-255-0616
Fax Number	:	941-295-7973

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/15/2014

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