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NPI Code Detail

MEDICARE: KENNETH DANIEL KOFFER LMHC

MEDICARE: KENNETH DANIEL KOFFER 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 CounselorMH20500FL

General Provider Information

NPI Number : 1558889550
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DANIEL KOFFER LMHC
Provider Business Mailing Address
First Line : 722 TRADE WAY
Second Line :
City : SANFORD
State : FL
Zip : 32771-8657
Country : US
Telephone Number : 833-769-3524
Fax Number : 407-915-4387
Provider Business Practice Location Address
First Line : 722 TRADE WAY
Second Line :
City : SANFORD
State : FL
Zip : 32771-8657
Country : US
Telephone Number : 833-769-3524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2017
Last Update Date : 01/05/2026

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