MEDICARE: STUART MENTAL HEALTH AND WELLNESS, LLC

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	SW11131	FL

General Provider Information

NPI Number	:	1871095513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART MENTAL HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 118
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34991-0118
Country	:	US
Telephone Number	:	772-763-9540
Fax Number	:	844-296-7702

Provider Business Practice Location Address
First Line	:	1207 SW SUNSET TRL
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3342
Country	:	US
Telephone Number	:	772-486-7249
Fax Number	:	833-485-0447

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN FITZGERALD HELLMANN
Credential	:	LCSW
Telephone Number	:	772-486-7249

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	08/19/2021

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