MEDICARE: DAWN M MORT MS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000117A	IN
2	101YM0800X	Mental Health Counselor	MH16045	FL
3	101YM0800X	Mental Health Counselor	39002221A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467593723	OTHER	FL	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467593723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M MORT MS

Provider Business Mailing Address
First Line	:	9176 GENEVA ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-6207
Country	:	US
Telephone Number	:	352-422-3711
Fax Number	:	352-623-5463

Provider Business Practice Location Address
First Line	:	10489 HELEY ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-3729
Country	:	US
Telephone Number	:	352-422-3711
Fax Number	:	352-623-5463

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/23/2021

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Directions to “ DAWN M MORT MS” Practice Location

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