MEDICARE: MS. JUDITH KAY WISHER MA, 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 8904	FL

General Provider Information

NPI Number	:	1811298243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH KAY WISHER MA, LMHC

Provider Business Mailing Address
First Line	:	1220 WILLIS AVE
Second Line	:	BOX 32
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2810
Country	:	US
Telephone Number	:	386-236-3234
Fax Number	:	383-236-3140

Provider Business Practice Location Address
First Line	:	3875 TIGER BAY RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-1063
Country	:	US
Telephone Number	:	386-236-3234
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	11/17/2010

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