MEDICARE: MARYANN TOLES LPC

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	101YP2500X	Professional Counselor	6401006048	MI

General Provider Information

NPI Number	:	1932417656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN TOLES LPC

Provider Business Mailing Address
First Line	:	18350 NW 2ND AVE
Second Line	:	SUITE 324
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4519
Country	:	US
Telephone Number	:	305-770-4565
Fax Number	:	305-770-4566

Provider Business Practice Location Address
First Line	:	18350 NW 2ND AVE
Second Line	:	SUITE 324
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4519
Country	:	US
Telephone Number	:	305-770-4565
Fax Number	:	305-770-4566

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	03/23/2012

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