MEDICARE: SUSAN ANN OLIVER 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	MH7191	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH7191	OTHER	FL	LICENSED MENTAL HEALTH COUNSELOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912442260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ANN OLIVER LMHC

Provider Business Mailing Address
First Line	:	3834 WINDRIDGE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7063
Country	:	US
Telephone Number	:	866-796-0530
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 BELFORT RD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6024
Country	:	US
Telephone Number	:	866-796-0530
Fax Number	:

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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