MEDICARE: MILES OF SMILES FOUNDATION, INC

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

General Provider Information

NPI Number	:	1356217954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILES OF SMILES FOUNDATION, INC

Provider Business Mailing Address
First Line	:	19810 GOTTARDE RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4563
Country	:	US
Telephone Number	:	239-810-0636
Fax Number	:

Provider Business Practice Location Address
First Line	:	19810 GOTTARDE RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4563
Country	:	US
Telephone Number	:	239-810-0636
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	GAIL DOXIE
Credential	:	LMHC
Telephone Number	:	239-810-0636

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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