MEDICARE: ABEDE FITZROY TESFA M.S./ED.S.

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

General Provider Information

NPI Number	:	1689922767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABEDE FITZROY TESFA M.S./ED.S.

Provider Business Mailing Address
First Line	:	1000 W THARPE ST
Second Line	:	SUITE 7
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-5374
Country	:	US
Telephone Number	:	850-561-8060
Fax Number	:	850-561-1143

Provider Business Practice Location Address
First Line	:	1000 W THARPE ST
Second Line	:	SUITE 7
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-5374
Country	:	US
Telephone Number	:	850-561-8060
Fax Number	:	850-561-1143

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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