MEDICARE: ARIELLE THEODORE 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	MH21158	FL

General Provider Information

NPI Number	:	1841911740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIELLE THEODORE LMHC

Provider Business Mailing Address
First Line	:	18900 N TAMIAMI TRL STE 9
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-7307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18900 N TAMIAMI TRL STE 9
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-7307
Country	:	US
Telephone Number	:	941-363-0878
Fax Number	:

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	04/05/2024

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Directions to “ ARIELLE THEODORE LMHC” Practice Location

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