=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396558367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDAL KRISTINA MITCHELL LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3607 US-19 ALT
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-732-4305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 COACH ST
-----------------------------------------------------
City | DERIDDER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70634-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-757-9005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH25013
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------