MEDICARE: MS. TINA FRIEDMAN 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	MH6989	FL

General Provider Information

NPI Number	:	1023337953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TINA FRIEDMAN LMHC

Provider Business Mailing Address
First Line	:	8695 COLLEGE PKWY
Second Line	:	2258
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4890
Country	:	US
Telephone Number	:	239-489-4705
Fax Number	:	239-489-2732

Provider Business Practice Location Address
First Line	:	8695 COLLEGE PKWY
Second Line	:	2258
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4890
Country	:	US
Telephone Number	:	239-489-4705
Fax Number	:	239-489-2732

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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