MEDICARE: VICTORIA VAN WYHE

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	MH6437	FL

General Provider Information

NPI Number	:	1154070712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA VAN WYHE

Provider Business Mailing Address
First Line	:	11973 PARK CENTRAL
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1686
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11973 PARK CENTRAL
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1686
Country	:	US
Telephone Number	:	954-806-3210
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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Directions to “ VICTORIA VAN WYHE ” Practice Location

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