Healthcare Provider Details

I. General information

NPI: 1033678347
Provider Name (Legal Business Name): JAMES NEAL KOCHENBURGER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 03/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 BRUTON BLVD
ORLANDO FL
32805-6608
US

IV. Provider business mailing address

2213 ONTARIO WAY
LAKELAND FL
33805-9632
US

V. Phone/Fax

Practice location:
  • Phone: 407-670-8289
  • Fax:
Mailing address:
  • Phone: 407-670-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: