MEDICARE: MADISON LYNN HENZEL

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	SW26528	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770166456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LYNN HENZEL

Provider Business Mailing Address
First Line	:	1000 W THARPE ST STE 9
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-5300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W THARPE ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-5374
Country	:	US
Telephone Number	:	813-295-8383
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	06/01/2026

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