MEDICARE: MRS. NICOLE A BAGGE 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	101YM0800X	Mental Health Counselor	MH 9507	FL

General Provider Information

NPI Number	:	1093958159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE A BAGGE LMHC

Provider Business Mailing Address
First Line	:	3307 NORTHLAKE BLVD
Second Line	:	B104
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1703
Country	:	US
Telephone Number	:	561-254-7226
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 NORTHLAKE BLVD
Second Line	:	B104
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1703
Country	:	US
Telephone Number	:	561-254-7226
Fax Number	:

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

Provider Enumeration Date	:	04/19/2009
Last Update Date	:	04/19/2009

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