MEDICARE: IVELISSE CORREA M.A

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	MH16164	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	:	1972982155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVELISSE CORREA M.A

Provider Business Mailing Address
First Line	:	PO BOX 1266
Second Line	:
City	:	SUMMERFIELD
State	:	FL
Zip	:	34492-1266
Country	:	US
Telephone Number	:	352-322-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2497 SW 27TH AVE # 1096
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-0807
Country	:	US
Telephone Number	:	352-322-8747
Fax Number	:

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	12/01/2023

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