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NPI Code Detail

MEDICARE: LYNN EDNA BRUESKE ED.S., LMHC

MEDICARE: LYNN EDNA BRUESKE ED.S., 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
1101YM0800XMental Health CounselorMH209FL

General Provider Information

NPI Number : 1952389439
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN EDNA BRUESKE ED.S., LMHC
Provider Business Mailing Address
First Line : 3810-1 WILLIAMSBURG PARK BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-9220
Country : US
Telephone Number : 904-733-9669
Fax Number : 904-733-4194
Provider Business Practice Location Address
First Line : 3810-1 WILLIAMSBURG PARK BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-9220
Country : US
Telephone Number : 904-733-9669
Fax Number : 904-733-4194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 07/08/2007

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