MEDICARE: EMR COUNSELING & THERAPY SERVICES, LLC

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 11985	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH 11985	OTHER	FL	STATE OF FLORIDA, DEPARTMENT OF HEALTH LICENSE

General Provider Information

NPI Number	:	1114340635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMR COUNSELING & THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	341 N MAITLAND AVE
Second Line	:	SUITE 200
City	:	MAITLAND
State	:	FL
Zip	:	32751-4783
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Provider Business Practice Location Address
First Line	:	341 N MAITLAND AVE
Second Line	:	SUITE 200
City	:	MAITLAND
State	:	FL
Zip	:	32751-4783
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDNA M RODRIGUEZ
Credential	:	EDD
Telephone Number	:	407-265-2100

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/04/2014

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