MEDICARE: MISS JOANNA GILLIAM LMFT

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	106H00000X	Marriage & Family Therapist	3672	FL

General Provider Information

NPI Number	:	1265010151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOANNA GILLIAM LMFT

Provider Business Mailing Address
First Line	:	1437 38TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-1048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 38TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-1048
Country	:	US
Telephone Number	:	620-481-4000
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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Directions to “ MISS JOANNA GILLIAM LMFT” Practice Location

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