MEDICARE: MR. TIM FRANCIS FITSIMONES L.M.H.C., C.A.P.

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	MH3669	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH3669	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1770541252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIM FRANCIS FITSIMONES L.M.H.C., C.A.P.

Provider Business Mailing Address
First Line	:	PO BOX 82
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-0082
Country	:	US
Telephone Number	:	407-629-7114
Fax Number	:	407-629-7463

Provider Business Practice Location Address
First Line	:	409 SAINT ANDREWS BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3409
Country	:	US
Telephone Number	:	407-629-7114
Fax Number	:	407-629-7463

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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