MEDICARE: CHILDREN'S ADVOCACY CENTER OF SW FL, INC

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

General Provider Information

NPI Number	:	1154324762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S ADVOCACY CENTER OF SW FL, INC

Provider Business Mailing Address
First Line	:	3900 BROADWAY
Second Line	:	STE B-1
City	:	FT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:	239-939-4794

Provider Business Practice Location Address
First Line	:	3900 BROADWAY
Second Line	:	STE B-1
City	:	FT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:	239-939-4794

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. JILL TURNER
Credential	:
Telephone Number	:	239-939-2808

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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