Healthcare Provider Details

I. General information

NPI: 1912243908
Provider Name (Legal Business Name): RUTH L MEJIAS M.S. LMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 AURORA RD
MELBOURNE FL
32935-5315
US

IV. Provider business mailing address

2367 DEERCROFT DR
MELBOURNE FL
32940-6353
US

V. Phone/Fax

Practice location:
  • Phone: 407-456-2746
  • Fax:
Mailing address:
  • Phone: 407-810-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: