Healthcare Provider Details

I. General information

NPI: 1356834089
Provider Name (Legal Business Name): KASBAR COUNSELING & CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLORADO AVE STE 208
STUART FL
34994-2103
US

IV. Provider business mailing address

300 COLORADO AVE STE 208
STUART FL
34994-2103
US

V. Phone/Fax

Practice location:
  • Phone: 954-245-1819
  • Fax:
Mailing address:
  • Phone: 954-245-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH10107
License Number StateFL

VIII. Authorized Official

Name: MRS. MIESHA MCINTOSH-KASBAR
Title or Position: LICENSED PSYCHOTHERAPIST
Credential: MS, LMHC, MCAP
Phone: 954-245-1819