=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710545116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGIA A BRYCE-HUTCHINSON LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2019
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3236 FORUM BLVD # 1028
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-5582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-471-8312
-----------------------------------------------------
Fax | 954-901-2778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2675 VIRGINIA CV
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30296-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-494-0700
-----------------------------------------------------
Fax | 954-901-2778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT3673
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------