MEDICARE: MENTAL HEALTH COLLABORATIVE COUNSELING

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	:	1912565656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH COLLABORATIVE COUNSELING

Provider Business Mailing Address
First Line	:	661 WASHINGTON ST STE 301
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3529
Country	:	US
Telephone Number	:	508-809-7540
Fax Number	:	508-202-1722

Provider Business Practice Location Address
First Line	:	661 WASHINGTON ST STE 301
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3529
Country	:	US
Telephone Number	:	508-809-7540
Fax Number	:	508-202-1722

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID NORRMAN
Credential	:	LMFT
Telephone Number	:	508-809-7540

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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