Healthcare Provider Details

I. General information

NPI: 1558889550
Provider Name (Legal Business Name): KENNETH DANIEL KOFFER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 TRADE WAY
SANFORD FL
32771-8657
US

IV. Provider business mailing address

3222 CORRINE DR STE A
ORLANDO FL
32803-2217
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax:
Mailing address:
  • Phone: 407-638-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: