MEDICARE: JOANNA R. DAVIS, LMHC CAP

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	MH10454	FL

General Provider Information

NPI Number	:	1578000683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA R. DAVIS, LMHC CAP

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32549-0879
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 E MIRACLE STRIP PKWY
Second Line	:	SUITE 602
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-1988
Country	:	US
Telephone Number	:	850-243-7035
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE SPECIALIST/ASST. MANAGER
Name	:	MARIA TUMANENG
Credential	:
Telephone Number	:	850-243-7035

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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