MEDICARE: BRIANNA DESOUZA

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	MH16967	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861844284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA DESOUZA

Provider Business Mailing Address
First Line	:	PO BOX 491000
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-1000
Country	:	US
Telephone Number	:	352-315-7500
Fax Number	:	352-315-7587

Provider Business Practice Location Address
First Line	:	1217 HUFFSTETLER DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-8225
Country	:	US
Telephone Number	:	352-483-1652
Fax Number	:

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

Provider Enumeration Date	:	07/09/2016
Last Update Date	:	05/22/2019

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Directions to “ BRIANNA DESOUZA ” Practice Location

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