MEDICARE: NICHOLAS HALSEY MHPP

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

General Provider Information

NPI Number	:	1912246422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS HALSEY MHPP

Provider Business Mailing Address
First Line	:	5749 WESTGATE DR STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5040
Country	:	US
Telephone Number	:	321-441-1567
Fax Number	:	479-452-5847

Provider Business Practice Location Address
First Line	:	5749 WESTGATE DR STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5040
Country	:	US
Telephone Number	:	321-441-1567
Fax Number	:	479-452-5847

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	09/20/2021

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