MEDICARE: KERRY LITTLE 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	MH7886	FL

General Provider Information

NPI Number	:	1023468865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY LITTLE LMHC

Provider Business Mailing Address
First Line	:	1842 RACQUET CT
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 W CYPRESS CREEK RD STE 300
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1953
Country	:	US
Telephone Number	:	954-482-3035
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	10/08/2021

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