MEDICARE: MRS. KWANYA TOUSSAINT 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	MH5631	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013155274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KWANYA TOUSSAINT LMHC

Provider Business Mailing Address
First Line	:	3270 SUNTREE BLVD STE 127
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7540
Country	:	US
Telephone Number	:	321-610-7949
Fax Number	:	321-610-7947

Provider Business Practice Location Address
First Line	:	3270 SUNTREE BLVD STE 127
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7540
Country	:	US
Telephone Number	:	321-610-7949
Fax Number	:	321-610-7947

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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