MEDICARE: CAROLYN HIX 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	101YP2500X	Professional Counselor	168607	KY
2	101YP2500X	Professional Counselor	MH22604	FL

General Provider Information

NPI Number	:	1437641859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN HIX LMHC

Provider Business Mailing Address
First Line	:	3425 BAYSIDE LAKES BLVD SE STE 103-1184
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	321-325-6935
Fax Number	:	321-325-6840

Provider Business Practice Location Address
First Line	:	3425 BAYSIDE LAKES BLVD SE STE 103-1184
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	321-325-6935
Fax Number	:	321-325-6840

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	02/05/2024

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