MEDICARE: MS. NANCY BAPTIST L.M.H.C. N.C.C.

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 9354	FL

General Provider Information

NPI Number	:	1407298318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY BAPTIST L.M.H.C. N.C.C.

Provider Business Mailing Address
First Line	:	6459 EGRET LN
Second Line	:	#420
City	:	BRADENTON
State	:	FL
Zip	:	34210-4214
Country	:	US
Telephone Number	:	941-556-1377
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 26TH ST W
Second Line	:	#100
City	:	BRADENTON
State	:	FL
Zip	:	34207-1712
Country	:	US
Telephone Number	:	941-556-1377
Fax Number	:

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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