Healthcare Provider Details

I. General information

NPI: 1679087050
Provider Name (Legal Business Name): LEMON BAY MENTAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 S MCCALL RD STE 3D
ENGLEWOOD FL
34223-4870
US

IV. Provider business mailing address

1500 S MCCALL RD
ENGLEWOOD FL
34223-4866
US

V. Phone/Fax

Practice location:
  • Phone: 941-681-0616
  • Fax: 941-894-0415
Mailing address:
  • Phone: 941-681-0616
  • Fax: 941-894-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14916
License Number StateFL

VIII. Authorized Official

Name: JERRY ERVIN KUHN
Title or Position: OWNER
Credential: LMHC
Phone: 941-681-0616