MEDICARE: JOHANNA REICKS 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	20443	FL
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629622782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA REICKS LMHC

Provider Business Mailing Address
First Line	:	1011 N 12TH AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3306
Country	:	US
Telephone Number	:	850-250-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 N 12TH AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3306
Country	:	US
Telephone Number	:	850-250-1441
Fax Number	:

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

Provider Enumeration Date	:	07/27/2019
Last Update Date	:	09/12/2022

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Directions to “ JOHANNA REICKS LMHC” Practice Location

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