MEDICARE: GILLIAN MELENDEZ HARRIS 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	101YM0800X	Mental Health Counselor	MH19440	FL

General Provider Information

NPI Number	:	1750073995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN MELENDEZ HARRIS LMHC

Provider Business Mailing Address
First Line	:	2624 NE 7TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4310
Country	:	US
Telephone Number	:	718-644-3948
Fax Number	:

Provider Business Practice Location Address
First Line	:	2624 NE 7TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4310
Country	:	US
Telephone Number	:	718-644-3948
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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