MEDICARE: ASHLEY POLYNICE 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	MH16871	FL

General Provider Information

NPI Number	:	1518428846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY POLYNICE LMHC

Provider Business Mailing Address
First Line	:	1193 SE PORT ST LUCIE BLVD # 339
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5332
Country	:	US
Telephone Number	:	754-216-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1193 SE PORT ST LUCIE BLVD # 339
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5332
Country	:	US
Telephone Number	:	754-216-4662
Fax Number	:

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	02/25/2025

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