MEDICARE: MARY WIHNYK 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	MH19221	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH19221	OTHER	FL	LICENSURE NUMBER

General Provider Information

NPI Number	:	1477127629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WIHNYK LMHC

Provider Business Mailing Address
First Line	:	4505 PRUNTY AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7148
Country	:	US
Telephone Number	:	352-871-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	12443 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8646
Country	:	US
Telephone Number	:	904-383-7613
Fax Number	:

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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Directions to “ MARY WIHNYK LMHC” Practice Location

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