MEDICARE: MICHAEL BLAKE-EDWARDS M.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
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor	MH21208	FL

General Provider Information

NPI Number	:	1982958385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BLAKE-EDWARDS M.S., LMHC

Provider Business Mailing Address
First Line	:	6750 N ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	954-951-2936
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 N ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	954-951-2936
Fax Number	:

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

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	01/03/2025

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