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NPI Code Detail

MEDICARE: MS. SOPHIA XIQUES MAS L.M.H.C.

MEDICARE: MS. SOPHIA XIQUES MAS L.M.H.C.
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
1101YM0800XMental Health CounselorMH 8174FL

General Provider Information

NPI Number : 1598826323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SOPHIA XIQUES MAS L.M.H.C.
Provider Business Mailing Address
First Line : 1007 GRAND HICKORY CIR
Second Line :
City : HOLLY HILL
State : FL
Zip : 32117-3139
Country : US
Telephone Number : 386-334-6397
Fax Number : 386-236-3162
Provider Business Practice Location Address
First Line : 301 JUSTICE LN
Second Line :
City : BUNNELL
State : FL
Zip : 32110-4487
Country : US
Telephone Number : 386-236-1726
Fax Number : 386-236-3162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 04/06/2017

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