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NPI Code Detail

MEDICARE: CHRISTI POLK LMFT

MEDICARE: CHRISTI POLK LMFT
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
1101Y00000XCounselor
2101YM0800XMental Health CounselorMT4100FL

General Provider Information

NPI Number : 1922387018
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTI POLK LMFT
Provider Business Mailing Address
First Line : 195 LEGENDS LN
Second Line :
City : HOLLISTER
State : MO
Zip : 65672-5855
Country : US
Telephone Number : 321-356-8055
Fax Number :
Provider Business Practice Location Address
First Line : 3505 LAKE LYNDA DR STE 200
Second Line :
City : ORLANDO
State : FL
Zip : 32817-8333
Country : US
Telephone Number : 407-992-4452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2011
Last Update Date : 08/18/2021

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Directions to “ CHRISTI POLK LMFT” Practice Location

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