Healthcare Provider Details

I. General information

NPI: 1104457761
Provider Name (Legal Business Name): KEVIN WERNHAM LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

11850 CROSS VINE DR
RIVERVIEW FL
33579-4300
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2346
  • Fax:
Mailing address:
  • Phone: 813-679-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: