MEDICARE: GWEN ZECHEL RN, 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	101Y00000X	Counselor	MH3208	FL

General Provider Information

NPI Number	:	1457345043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN ZECHEL RN, LMHC

Provider Business Mailing Address
First Line	:	3205 SOUTHGATE CIR # 11
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5514
Country	:	US
Telephone Number	:	941-356-7245
Fax Number	:	941-927-2764

Provider Business Practice Location Address
First Line	:	3205 SOUTHGATE CIR # 11
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5514
Country	:	US
Telephone Number	:	941-356-7245
Fax Number	:	941-927-2764

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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