MEDICARE: WILLINDA ZELLA LUMPKIN 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	20968	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20968	OTHER		STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1669106670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLINDA ZELLA LUMPKIN LMHC

Provider Business Mailing Address
First Line	:	3800 W BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1018
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:

Provider Business Practice Location Address
First Line	:	CHYSALIS CENTER 3800 W BROWARD BLVD.
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3331
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:

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

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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