MEDICARE: ODALYS J. WAUGH 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	MH8795	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH8795	OTHER	FL	LIC MENTAL HEALTH COUNS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790715514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODALYS J. WAUGH LMHC

Provider Business Mailing Address
First Line	:	9000 SW 137TH AVE STE 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1435
Country	:	US
Telephone Number	:	305-671-3503
Fax Number	:	305-671-3505

Provider Business Practice Location Address
First Line	:	9000 SW 137TH AVE STE 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1435
Country	:	US
Telephone Number	:	305-671-3503
Fax Number	:	305-671-3505

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/05/2024

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Directions to “ ODALYS J. WAUGH LMHC” Practice Location

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