MEDICARE: MILLIE BRODICH 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	101YP2500X	Professional Counselor	MH8358	FL

General Provider Information

NPI Number	:	1235261751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLIE BRODICH LMHC, NCC

Provider Business Mailing Address
First Line	:	5006 TROUBLE CREEK RD
Second Line	:	SUITE 222
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4922
Country	:	US
Telephone Number	:	727-842-3506
Fax Number	:	727-842-2050

Provider Business Practice Location Address
First Line	:	5006 TROUBLE CREEK RD
Second Line	:	SUITE 222
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4922
Country	:	US
Telephone Number	:	727-842-3506
Fax Number	:	727-842-2050

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

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	07/08/2007

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