MEDICARE: MRS. SALLY A DAVID MA 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	01548	FL

General Provider Information

NPI Number	:	1295737732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY A DAVID MA LMHC

Provider Business Mailing Address
First Line	:	651 OAK HOLLOW WAY
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1811
Country	:	US
Telephone Number	:	407-293-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 LEE RD
Second Line	:	STE 305
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2115
Country	:	US
Telephone Number	:	407-975-0415
Fax Number	:	407-975-0417

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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