MEDICARE: JANET NICHOLS 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	MH7543	FL

General Provider Information

NPI Number	:	1043421217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET NICHOLS LMHC

Provider Business Mailing Address
First Line	:	2796 FAWN DR
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-2582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12794 W FOREST HILL BLVD
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-452-2939
Fax Number	:

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

Provider Enumeration Date	:	05/26/2007
Last Update Date	:	07/08/2007

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