MEDICARE: ASHLEY KORKIDIS BUCHANAN 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	104100000X	Social Worker	MH19400	FL
2	171M00000X	Case Manager/Care Coordinator	MH19400	FL
3	101YM0800X	Mental Health Counselor	MH19400	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

General Provider Information

NPI Number	:	1902548340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KORKIDIS BUCHANAN LMHC

Provider Business Mailing Address
First Line	:	4740 N STATE ROAD 7 STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5839
Country	:	US
Telephone Number	:	954-486-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 N MILITARY TRL STE 3-5
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-7429
Country	:	US
Telephone Number	:	561-486-0848
Fax Number	:

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	01/05/2026

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