MEDICARE: MS. ANITA M. PEMBLETON 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	MH 8956	FL
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1750567707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA M. PEMBLETON LMHC

Provider Business Mailing Address
First Line	:	PO BOX 977
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402-0977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 E 15TH ST STE C
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7423
Country	:	US
Telephone Number	:	850-763-8100
Fax Number	:

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

Provider Enumeration Date	:	01/20/2008
Last Update Date	:	03/09/2015

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