Healthcare Provider Details

I. General information

NPI: 1447926076
Provider Name (Legal Business Name): AVERY MAY MH 19441
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EVERNIA ST APT 1319
WEST PALM BEACH FL
33401-5689
US

IV. Provider business mailing address

255 EVERNIA ST APT 1319
WEST PALM BEACH FL
33401-5689
US

V. Phone/Fax

Practice location:
  • Phone: 860-227-3681
  • Fax:
Mailing address:
  • Phone: 860-227-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: