MEDICARE: LAKSHMI SUBRAHMANIAN, MS, LMHC, PA

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	302R00000X	Health Maintenance Organization	MH5814	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306832555	OTHER	FL	NPI TYPE 1

General Provider Information

NPI Number	:	1760802185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKSHMI SUBRAHMANIAN, MS, LMHC, PA

Provider Business Mailing Address
First Line	:	11851 NW 10TH PL
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5047
Country	:	US
Telephone Number	:	954-655-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 N UNIVERSITY DR
Second Line	:	SUITE 201
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-8903
Country	:	US
Telephone Number	:	954-755-7091
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAKSHMI SUBRAHMANIAN
Credential	:	LMHC
Telephone Number	:	955-655-7040

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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