MEDICARE: AMY LOUISE HENSLEY M.S.

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

General Provider Information

NPI Number	:	1073864054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LOUISE HENSLEY M.S.

Provider Business Mailing Address
First Line	:	2814 S. US HWY 1 STE. D-4
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	352-504-5229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 S. US HWY 1 STE. D-4
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	352-504-5229
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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