Healthcare Provider Details

I. General information

NPI: 1073196457
Provider Name (Legal Business Name): SOPHIA ISABELLE KIRI M.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA ISABELLE BESUNDER M.ED, LMHC

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 18162
ERLANGER KY
41018-0162
US

IV. Provider business mailing address

PO BOX 18162
ERLANGER KY
41018-0162
US

V. Phone/Fax

Practice location:
  • Phone: 561-577-6202
  • Fax:
Mailing address:
  • Phone: 561-577-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: