MEDICARE: CAROLINE PACE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH21010	FL

General Provider Information

NPI Number	:	1003543273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE PACE LMHC

Provider Business Mailing Address
First Line	:	5637 NW COVENTRY CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4056
Country	:	US
Telephone Number	:	561-201-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 ORANGE AVE # M-205
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4304
Country	:	US
Telephone Number	:	772-207-1095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2022
Last Update Date	:	08/06/2022

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