MEDICARE: ABRAHAM TIRADO AYALA CBHCM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		FL
2	171M00000X	Case Manager/Care Coordinator	CBHCM103930	FL

General Provider Information

NPI Number	:	1679146997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABRAHAM TIRADO AYALA CBHCM

Provider Business Mailing Address
First Line	:	1604 17TH TER NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4416
Country	:	US
Telephone Number	:	863-288-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 17TH TER NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4416
Country	:	US
Telephone Number	:	863-288-1635
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	09/16/2025

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