MEDICARE: CODIE AMOS 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	14811	FL

General Provider Information

NPI Number	:	1811436371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODIE AMOS LMHC

Provider Business Mailing Address
First Line	:	6456 WELANNEE BLVD
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-7309
Country	:	US
Telephone Number	:	850-612-6466
Fax Number	:

Provider Business Practice Location Address
First Line	:	6456 WELANNEE BLVD
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-7309
Country	:	US
Telephone Number	:	850-612-6466
Fax Number	:

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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Directions to “ CODIE AMOS LMHC” Practice Location

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