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General NPI Number Information
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NPI Number | 1407072457
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Entity Type | Organization
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Legal Business Name | KINZIE COUNSELING & CONSULTATION LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 73 S PALM AVE STE 215
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City | SARASOTA
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State | FL
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Zip | 34236-5638
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Country | US
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Telephone | 941-374-3846
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Fax | 941-751-4885
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Provider Business Mailing Address
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Address Line | 6620 QUONSET RD
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City | BRADENTON
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State | FL
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Zip | 34203-9730
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Country | US
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Telephone | 941-374-3846
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Fax | 941-751-4885
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Authorized Official
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Title or Position | MGR
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Name | MR. KENNETH M. KINZIE
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Credential | MSW, LCSW
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Telephone | 941-374-3846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW1660
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License Number State | FL
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