MEDICARE: MRS. LYNN H POWELL LMHC, CTRS

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	101YP2500X	Professional Counselor	MH7726	FL

General Provider Information

NPI Number	:	1417398835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN H POWELL LMHC, CTRS

Provider Business Mailing Address
First Line	:	4540 SOUTHSIDE BLVD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5492
Country	:	US
Telephone Number	:	904-566-9256
Fax Number	:	904-595-5199

Provider Business Practice Location Address
First Line	:	4540 SOUTHSIDE BLVD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5492
Country	:	US
Telephone Number	:	904-566-9256
Fax Number	:	904-595-5199

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

Provider Enumeration Date	:	07/14/2013
Last Update Date	:	07/14/2013

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