MEDICARE: CYNTHIA ALLEN SUICH 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	MH 7166	FL

General Provider Information

NPI Number	:	1033256367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ALLEN SUICH LMHC

Provider Business Mailing Address
First Line	:	77 SHADOW LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3592
Country	:	US
Telephone Number	:	863-647-1570
Fax Number	:	863-709-8118

Provider Business Practice Location Address
First Line	:	4404 S FLORIDA AVE
Second Line	:	SUITE 3
City	:	LAKELAND
State	:	FL
Zip	:	33813-2169
Country	:	US
Telephone Number	:	863-709-8110
Fax Number	:	863-709-8118

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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