MEDICARE: WANDA JEAN MORROW 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	101YM0800X	Mental Health Counselor	MH15402	FL

General Provider Information

NPI Number	:	1285144741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA JEAN MORROW LMHC

Provider Business Mailing Address
First Line	:	94 BAYSIDE DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8819
Country	:	US
Telephone Number	:	423-368-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 PALM COAST PKWY SW UNIT 1
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4782
Country	:	US
Telephone Number	:	386-597-2904
Fax Number	:	386-597-2903

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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