Request for Mental Health and Wellness Benefits Mental Health benefits requested by: Select OneBeneficiary themselvesDoctor / PCP Beneficiary Insurance: Select OneTraditional / Straight MedicareMedicare Advantage ( HMO / PPO ) Location for benefits to be provided: Select OneAL or IL addressTheraCounsel office: 4546 North Federal highway Ft. Lauderdale FL 33305.
