MEDICARE: MR. BRYN EVAN MARCUS LMHC

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	MH8583	FL

General Provider Information

NPI Number	:	1427199355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYN EVAN MARCUS LMHC

Provider Business Mailing Address
First Line	:	5221 SW 8TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-7012
Country	:	US
Telephone Number	:	941-504-9759
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 BROADWAY STE B1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:	239-939-4794

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/09/2007

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