MEDICARE: DANIELLE C PROCH LMHC, NCC

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	MH16044	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L18000138775	OTHER	FL	1154813822
2	100314146821	OTHER		1154813822

General Provider Information

NPI Number	:	1154813822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE C PROCH LMHC, NCC

Provider Business Mailing Address
First Line	:	334 E LAKE RD # 280
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	888-732-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 E LAKE RD # 280
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	888-732-2313
Fax Number	:	727-228-2271

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

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	03/06/2021

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