MEDICARE: MITHRAN GODFREY CABOT

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

General Provider Information

NPI Number	:	1982708004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITHRAN GODFREY CABOT

Provider Business Mailing Address
First Line	:	308 LAKESHORE DR
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-9194
Country	:	US
Telephone Number	:	386-585-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 LAKESHORE DR
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-9194
Country	:	US
Telephone Number	:	386-585-0293
Fax Number	:

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	06/12/2013

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