Healthcare Provider Details

I. General information

NPI: 1033486477
Provider Name (Legal Business Name): TABITHA KUHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 BURGUNDY PL
LAKELAND FL
33813-2301
US

IV. Provider business mailing address

4616 BURGUNDY PL
LAKELAND FL
33813-2301
US

V. Phone/Fax

Practice location:
  • Phone: 386-559-0227
  • Fax:
Mailing address:
  • Phone: 385-559-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: