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NPI Code Detail

MEDICARE: KATHY DICKSON

MEDICARE: KATHY DICKSON
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
1101Y00000XCounselor
2101YM0800XMental Health Counselor

Other Identifiers

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

General Provider Information

NPI Number : 1063555092
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY DICKSON
Provider Business Mailing Address
First Line : 126 LITHIA PINECREST RD
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 126 LITHIA PINECREST RD
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number : 813-689-8828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 06/28/2022

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Directions to “ KATHY DICKSON ” Practice Location

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