MEDICARE: ALLISON GLORIOSO LMHC, NCC

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	IMH11665	FL

General Provider Information

NPI Number	:	1619378924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON GLORIOSO LMHC, NCC

Provider Business Mailing Address
First Line	:	15050 ELDERBERRY LN
Second Line	:	SUITE 4
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8504
Country	:	US
Telephone Number	:	239-789-8464
Fax Number	:	844-308-8873

Provider Business Practice Location Address
First Line	:	15050 ELDERBERRY LN
Second Line	:	SUITE 4
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8504
Country	:	US
Telephone Number	:	239-789-8464
Fax Number	:	844-308-8873

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

Provider Enumeration Date	:	09/07/2014
Last Update Date	:	07/09/2016

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