MEDICARE: FAITH IN VISIONS REALIZED

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	11914	FL

General Provider Information

NPI Number	:	1679019525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH IN VISIONS REALIZED

Provider Business Mailing Address
First Line	:	2833 NW 41ST ST STE 100
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6986
Country	:	US
Telephone Number	:	352-339-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 NW 41ST ST STE 100
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6986
Country	:	US
Telephone Number	:	352-339-5848
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	AMANDA PAGAN
Credential	:	LMHC
Telephone Number	:	352-339-5848

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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Directions to “FAITH IN VISIONS REALIZED ” Practice Location

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