MEDICARE: SABRINA BIVINS 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	101Y00000X	Counselor	MH14202	FL
2	101YM0800X	Mental Health Counselor	MH14202	FL
3	101YP2500X	Professional Counselor	MH14202	FL

General Provider Information

NPI Number	:	1073055075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA BIVINS LMHC

Provider Business Mailing Address
First Line	:	611 CENTER ST
Second Line	:	7
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 CENTER ST
Second Line	:	7
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3153
Country	:	US
Telephone Number	:	850-396-2938
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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