MEDICARE: MIA LAUREN WILLIAMS MS

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	MH9983	FL

General Provider Information

NPI Number	:	1770156184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA LAUREN WILLIAMS MS

Provider Business Mailing Address
First Line	:	1353 N COURTENAY PKWY STE L
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4463
Country	:	US
Telephone Number	:	319-785-5122
Fax Number	:	321-978-5127

Provider Business Practice Location Address
First Line	:	1353 N COURTENAY PKWY STE L
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4463
Country	:	US
Telephone Number	:	321-978-5122
Fax Number	:	321-978-5127

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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