MEDICARE: VIVIAN MEHNERT 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	101Y00000X	Counselor	MH6758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z9741	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	354703000	OTHER	FL	MAGELLAN

General Provider Information

NPI Number	:	1699762096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN MEHNERT LMHC

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	BARTOW
State	:	FL
Zip	:	33831-1559
Country	:	US
Telephone Number	:	863-519-0575
Fax Number	:	863-582-9251

Provider Business Practice Location Address
First Line	:	1835 GILMORE AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-3017
Country	:	US
Telephone Number	:	863-248-3300
Fax Number	:	863-534-7028

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/20/2008

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