MEDICARE: KATHY MAE FLORENCE MFTA

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	101YP2500X	Professional Counselor	A134	AL
2	101YM0800X	Mental Health Counselor	A134	AL

General Provider Information

NPI Number	:	1174251110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY MAE FLORENCE MFTA

Provider Business Mailing Address
First Line	:	3309 BOB WALLACE AVE SW STE 1
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-4007
Country	:	US
Telephone Number	:	256-686-9195
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 COLONIAL LAKE DR APT 511
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2272
Country	:	US
Telephone Number	:	334-538-6840
Fax Number	:

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

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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