Healthcare Provider Details

I. General information

NPI: 1902946171
Provider Name (Legal Business Name): LEEANN KOT M.A., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N WYMORE RD SUITE 200
WINTER PARK FL
32789-2808
US

IV. Provider business mailing address

3824 HERITAGE OAKS CT
OVIEDO FL
32765-9200
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-2565
  • Fax: 407-975-2586
Mailing address:
  • Phone: 407-592-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: