MEDICARE: AUBREY GREER OUGHTERSON

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	27446	FL

General Provider Information

NPI Number	:	1366246357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY GREER OUGHTERSON

Provider Business Mailing Address
First Line	:	3044 SE DARIEN RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5814
Country	:	US
Telephone Number	:	904-802-1795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 SW BAYSHORE BLVD STE 233
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-3519
Country	:	US
Telephone Number	:	772-353-2485
Fax Number	:

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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