Healthcare Provider Details

I. General information

NPI: 1174561203
Provider Name (Legal Business Name): ELIZABETH ANNE DUBOIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2194 AIA SUITE 203
INDIAN HARBOUR BEACH FL
32937-4931
US

IV. Provider business mailing address

2194 AIA SUITE 203
INDIAN HARBOUR BEACH FL
32937-4931
US

V. Phone/Fax

Practice location:
  • Phone: 321-777-8930
  • Fax: 321-773-5479
Mailing address:
  • Phone: 321-777-8930
  • Fax: 321-773-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH00001551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: