MEDICARE: VANOUCHE GERVAIS NCC, LMHC, MS

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	106H00000X	Marriage & Family Therapist	IMT3214	FL
2	101YM0800X	Mental Health Counselor	MH21024	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922517739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANOUCHE GERVAIS NCC, LMHC, MS

Provider Business Mailing Address
First Line	:	1123 NW 118TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-6238
Country	:	US
Telephone Number	:	904-226-0015
Fax Number	:

Provider Business Practice Location Address
First Line	:	7971 RIVIERA BLVD STE 316
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6448
Country	:	US
Telephone Number	:	305-570-4064
Fax Number	:

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

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	08/02/2022

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