Healthcare Provider Details

I. General information

NPI: 1801270541
Provider Name (Legal Business Name): LAURIE-ANNE C KUZEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S RED EAGLE TER
HOMOSASSA FL
34448-7326
US

IV. Provider business mailing address

3844 S RED EAGLE TER
HOMOSASSA FL
34448-7326
US

V. Phone/Fax

Practice location:
  • Phone: 352-634-1168
  • Fax:
Mailing address:
  • Phone: 352-634-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH12757
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: