Healthcare Provider Details

I. General information

NPI: 1528362498
Provider Name (Legal Business Name): KIMBERLY TREHARNE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 17TH ST
SARASOTA FL
34235-8904
US

IV. Provider business mailing address

3300 17TH ST
SARASOTA FL
34235-8904
US

V. Phone/Fax

Practice location:
  • Phone: 941-217-6503
  • Fax: 941-960-1123
Mailing address:
  • Phone: 941-217-6503
  • Fax: 941-960-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMASTER'S
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: