MEDICARE: HOLLY FREGIN RMHCI

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	18313	FL

General Provider Information

NPI Number	:	1447817549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY FREGIN RMHCI

Provider Business Mailing Address
First Line	:	2717 W CYPRESS CREEK RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1756
Country	:	US
Telephone Number	:	954-979-7911
Fax Number	:	954-302-4960

Provider Business Practice Location Address
First Line	:	2717 W CYPRESS CREEK RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1756
Country	:	US
Telephone Number	:	954-979-7911
Fax Number	:	954-302-4960

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

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	06/11/2019

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