MEDICARE: THOMAS HASELWOOD 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	MH2832	FL

General Provider Information

NPI Number	:	1881680999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS HASELWOOD MA, LMHC

Provider Business Mailing Address
First Line	:	1601 PARK CENTER DR
Second Line	:	#12
City	:	ORLANDO
State	:	FL
Zip	:	32835-5700
Country	:	US
Telephone Number	:	407-521-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 PARK CENTER DR
Second Line	:	#12
City	:	ORLANDO
State	:	FL
Zip	:	32835-5700
Country	:	US
Telephone Number	:	407-521-1811
Fax Number	:

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	03/10/2008

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