MEDICARE: CLEVERICK M ADAMS LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MAC-23612	FL
2	101YM0800X	Mental Health Counselor	MH8349	FL
3	103TP2701X	Group Psychotherapy Psychologist	MH8349	FL

General Provider Information

NPI Number	:	1245421841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEVERICK M ADAMS LMHC

Provider Business Mailing Address
First Line	:	7432 HIGHWAY 50
Second Line	:	SUITE 109
City	:	GROVELAND
State	:	FL
Zip	:	34736-9322
Country	:	US
Telephone Number	:	407-470-2195
Fax Number	:	407-445-9145

Provider Business Practice Location Address
First Line	:	7432 HIGHWAY 50
Second Line	:	SUITE 109
City	:	GROVELAND
State	:	FL
Zip	:	34736-9322
Country	:	US
Telephone Number	:	407-470-2195
Fax Number	:	407-445-9145

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

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

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