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NPI Code Detail

MEDICARE: KENNETH CHISHOLM LMHC

MEDICARE: KENNETH CHISHOLM 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
1101YM0800XMental Health CounselorMH 0004904FL

General Provider Information

NPI Number : 1700876711
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH CHISHOLM LMHC
Provider Business Mailing Address
First Line : 525 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5412
Country : US
Telephone Number : 850-522-4485
Fax Number : 850-914-6281
Provider Business Practice Location Address
First Line : 525 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5412
Country : US
Telephone Number : 850-522-4485
Fax Number : 850-914-6281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 07/08/2007

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Directions to “ KENNETH CHISHOLM LMHC” Practice Location

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