MEDICARE: MRS. LINDSAY K GOMEZ MH17282

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	MH17282	FL

General Provider Information

NPI Number	:	1912256504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSAY K GOMEZ MH17282

Provider Business Mailing Address
First Line	:	8260 COLLEGE PKWY STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5105
Country	:	US
Telephone Number	:	239-246-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	8260 COLLEGE PKWY STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5105
Country	:	US
Telephone Number	:	239-246-8774
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	09/14/2023

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