Healthcare Provider Details

I. General information

NPI: 1871838722
Provider Name (Legal Business Name): CATHERINE DOE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N DIXIE HWY
LAKE WORTH BEACH FL
33460-3079
US

IV. Provider business mailing address

201 N DIXIE HWY
LAKE WORTH BEACH FL
33460-3079
US

V. Phone/Fax

Practice location:
  • Phone: 561-533-9699
  • Fax: 561-318-6671
Mailing address:
  • Phone: 561-533-9699
  • Fax: 561-318-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: