Healthcare Provider Details

I. General information

NPI: 1083359806
Provider Name (Legal Business Name): MARY KATHRYN WRENCH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5934 NW 30TH TER
GAINESVILLE FL
32653-1826
US

IV. Provider business mailing address

5934 NW 30TH TER
GAINESVILLE FL
32653-1826
US

V. Phone/Fax

Practice location:
  • Phone: 352-359-3897
  • Fax:
Mailing address:
  • Phone: 352-359-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: