Healthcare Provider Details

I. General information

NPI: 1376794735
Provider Name (Legal Business Name): JERYL ANN KOST LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 N FEDERAL HWY SUITE 104
BOCA RATON FL
33487-1660
US

IV. Provider business mailing address

16130 POPPYSEED CIR UNIT 1302
DELRAY BEACH FL
33484-6331
US

V. Phone/Fax

Practice location:
  • Phone: 561-445-5430
  • Fax:
Mailing address:
  • Phone: 561-445-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH7046
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND1625
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7046
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND1625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: