MEDICARE: AMBER DAVELINE SMITH 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	101YP2500X	Professional Counselor	MH9223	FL

General Provider Information

NPI Number	:	1013106749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER DAVELINE SMITH LMHC

Provider Business Mailing Address
First Line	:	3121 INNOVATION DR STE A
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-922-4390
Fax Number	:	407-429-3977

Provider Business Practice Location Address
First Line	:	3121 INNOVATION DR STE A
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-922-4390
Fax Number	:	407-429-3977

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	03/17/2018

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