MEDICARE: INTELLEX ENTERPRISES, INC.

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	101YS0200X	School Counselor		AZ

General Provider Information

NPI Number	:	1750619862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTELLEX ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	3802 EHRLICH RD
Second Line	:	SUITE NUMBER 204
City	:	TAMPA
State	:	FL
Zip	:	33624-2378
Country	:	US
Telephone Number	:	813-968-4497
Fax Number	:

Provider Business Practice Location Address
First Line	:	9908 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1858
Country	:	US
Telephone Number	:	813-926-4009
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUDY A JOHNSON
Credential	:	PHD, MA, MED
Telephone Number	:	813-987-9760

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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