MEDICARE: JULIA DAWOUD 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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	MH15167	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14081190	OTHER	FL	CAQH

General Provider Information

NPI Number	:	1740541028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA DAWOUD LMHC

Provider Business Mailing Address
First Line	:	6006 GRAND PALM DR APT 520
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2664
Country	:	US
Telephone Number	:	508-783-6807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 BUSCH LAKE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1860
Country	:	US
Telephone Number	:	813-358-7487
Fax Number	:

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	07/21/2022

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