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NPI Code Detail

MEDICARE: MS. LOUISA ETHEREDGE M.ED. IN COUN. ED.

MEDICARE: MS. LOUISA ETHEREDGE M.ED. IN COUN. ED.
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
1101YM0800XMental Health CounselorMH 3352FL

General Provider Information

NPI Number : 1457454779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LOUISA ETHEREDGE M.ED. IN COUN. ED.
Provider Business Mailing Address
First Line : 837 BROOKSTONE CT
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32259-4321
Country : US
Telephone Number : 904-287-4427
Fax Number :
Provider Business Practice Location Address
First Line : 5776 SAINT AUGUSTINE RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8030
Country : US
Telephone Number : 904-448-4700
Fax Number : 904-448-4717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 07/08/2007

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