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NPI Code Detail

MEDICARE: SIMONE E MACK LMHC

MEDICARE:   SIMONE E MACK  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
1101Y00000XCounselor13402FL
2101YA0400XAddiction (Substance Use Disorder) Counselor13402FL
3101YM0800XMental Health Counselor13402FL

General Provider Information

NPI Number : 1508365495
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMONE E MACK LMHC
Provider Business Mailing Address
First Line : 17334 W SYCAMORE DR
Second Line :
City : LOXAHATCHEE
State : FL
Zip : 33470-5420
Country : US
Telephone Number : 561-336-1303
Fax Number :
Provider Business Practice Location Address
First Line : 1033 N CONGRESS AVE
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33409-5144
Country : US
Telephone Number : 561-386-8413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2018
Last Update Date : 02/12/2021

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Directions to “ SIMONE E MACK LMHC” Practice Location

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