MEDICARE: ALL-N-ONE THERAPY, INC

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	251S00000X	Community/Behavioral Health Agency	MH7058	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10	OTHER	FL	MENTAL HEALTH COUNSELOR

General Provider Information

NPI Number	:	1659572253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL-N-ONE THERAPY, INC

Provider Business Mailing Address
First Line	:	1011 GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-784-7888
Fax Number	:	850-387-1445

Provider Business Practice Location Address
First Line	:	1011 GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-784-7888
Fax Number	:	850-387-1445

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARVIN PORTER
Credential	:	ED.D
Telephone Number	:	850-784-7888

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	02/23/2009

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