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NPI Code Detail

MEDICARE: ALIA KHEDEROO LMHC

MEDICARE: ALIA KHEDEROO 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
1101YP2500XProfessional CounselorMH22639FL
2101YM0800XMental Health CounselorMH22639FL

General Provider Information

NPI Number : 1922408939
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALIA KHEDEROO LMHC
Provider Business Mailing Address
First Line : 4575 SE DIXIE HWY
Second Line :
City : STUART
State : FL
Zip : 34997-6826
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 6000 LAKE ELLENOR DR
Second Line :
City : ORLANDO
State : FL
Zip : 32809-4615
Country : US
Telephone Number : 407-613-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2014
Last Update Date : 03/26/2026

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Directions to “ ALIA KHEDEROO LMHC” Practice Location

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