MEDICARE: ANDREA FUENTES 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 13417	FL

General Provider Information

NPI Number	:	1114301926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA FUENTES LMHC

Provider Business Mailing Address
First Line	:	5220 HOOD RD
Second Line	:	SUITE 102
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-8910
Country	:	US
Telephone Number	:	561-635-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 HOOD RD
Second Line	:	SUITE 102
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-8910
Country	:	US
Telephone Number	:	561-635-9226
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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