MEDICARE: MS. ANN WHITE

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	IMH13116	FL

General Provider Information

NPI Number	:	1073996690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN WHITE

Provider Business Mailing Address
First Line	:	2835 WILEY ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5661
Country	:	US
Telephone Number	:	754-244-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 WILEY ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5661
Country	:	US
Telephone Number	:	754-244-6056
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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Directions to “ MS. ANN WHITE ” Practice Location

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