Healthcare Provider Details

I. General information

NPI: 1730806324
Provider Name (Legal Business Name): KALI KNIGHT MFT REG INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 LINCOLN RD
MIAMI BEACH FL
33139-3020
US

IV. Provider business mailing address

2105 KEYSTONE BLVD
NORTH MIAMI FL
33181-2610
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-2944
  • Fax:
Mailing address:
  • Phone: 305-527-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMT3801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: