MEDICARE: NICOLE MATEO LPC-S

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	101YP2500X	Professional Counselor	IMH6096	FL
2	101YP2500X	Professional Counselor	68091	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	891LPR	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821272808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MATEO LPC-S

Provider Business Mailing Address
First Line	:	9 OLD KINGS RD N # 1193
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4603
Country	:	US
Telephone Number	:	386-576-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 OLD KINGS RD N # 1193
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4603
Country	:	US
Telephone Number	:	386-576-2570
Fax Number	:

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	03/31/2026

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Directions to “ NICOLE MATEO LPC-S” Practice Location

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