MEDICARE: TOMMY GILBERT JR. M.S.

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	MH 1660	FL

General Provider Information

NPI Number	:	1386925063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMY GILBERT JR. M.S.

Provider Business Mailing Address
First Line	:	1625 36TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3026
Country	:	US
Telephone Number	:	772-567-6588
Fax Number	:

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	03/24/2013

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