MEDICARE: SANDRA SALSBURG L.M.H.C.

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	MH6157	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z9474	OTHER	FL	BCBSFL

General Provider Information

NPI Number	:	1730484049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SALSBURG L.M.H.C.

Provider Business Mailing Address
First Line	:	PO BOX 3392
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33402-3392
Country	:	US
Telephone Number	:	561-628-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 FOREST HILL BLVD STE 105
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6058
Country	:	US
Telephone Number	:	561-628-1196
Fax Number	:

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	01/18/2011

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