MEDICARE: CANDICE BURCH M.S

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

General Provider Information

NPI Number	:	1518688837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE BURCH M.S

Provider Business Mailing Address
First Line	:	1032 E BRANDON BLVD # 7770
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 WINKLER AVE APT M207
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9261
Country	:	US
Telephone Number	:	813-308-9744
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “ CANDICE BURCH M.S” Practice Location

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