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NPI Code Detail

MEDICARE: VIDA L BRINSON LMHC

MEDICARE: VIDA L BRINSON 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
1101YM0800XMental Health CounselorMH8260FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z085GOTHERFLBCBS

General Provider Information

NPI Number : 1730174384
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIDA L BRINSON LMHC
Provider Business Mailing Address
First Line : 3686 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8463
Country : US
Telephone Number : 850-892-8045
Fax Number : 850-892-8039
Provider Business Practice Location Address
First Line : 3686 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8463
Country : US
Telephone Number : 850-892-8045
Fax Number : 850-892-8039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/08/2007

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