MEDICARE: MS. SANDRA A. KOLESAR MA, LMHC

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	MH 10752	FL

General Provider Information

NPI Number	:	1780081406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA A. KOLESAR MA, LMHC

Provider Business Mailing Address
First Line	:	350 ALT 19
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	727-254-9183
Fax Number	:	888-345-7010

Provider Business Practice Location Address
First Line	:	350 ALT 19
Second Line	:	SUITE C
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	727-254-9183
Fax Number	:	888-345-7010

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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