MEDICARE: ANA FATANI MS, RMHCI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	IMH20691	FL
2	101YM0800X	Mental Health Counselor	IMH20691	FL

General Provider Information

NPI Number	:	1093472151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA FATANI MS, RMHCI

Provider Business Mailing Address
First Line	:	912 NORTHERN DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33403-2018
Country	:	US
Telephone Number	:	561-714-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3727
Country	:	US
Telephone Number	:	561-714-3434
Fax Number	:

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

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	11/23/2021

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