MEDICARE: MISS KAREN ANN GRIECO 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	LMH6721	FL

General Provider Information

NPI Number	:	1457465056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAREN ANN GRIECO LMHC

Provider Business Mailing Address
First Line	:	829 SW 47TH TER
Second Line	:	APT 202
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4306
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 BROADWAY
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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