MEDICARE: MISS MEGHAN MARIE FENCER 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	MH10539	FL

General Provider Information

NPI Number	:	1508050089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGHAN MARIE FENCER LMHC

Provider Business Mailing Address
First Line	:	1015 ATLANTIC BLVD # 208
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3313
Country	:	US
Telephone Number	:	904-651-0237
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 WOODCOCK DR
Second Line	:	MIDTOWN CENTRE BUILDING 2200 SUITE 232
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2720
Country	:	US
Telephone Number	:	904-651-0237
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	06/15/2011

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