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General NPI Number Information
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NPI Number | 1447519913
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Entity Type | Organization
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Legal Business Name | MK NEW LIFE
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 3800 S TAMIAMI TRL PARADISE PLAZA SUITE 305
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City | SARASOTA
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State | FL
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Zip | 34239-6908
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Country | US
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Telephone | 941-275-7966
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Fax | 941-429-7705
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Provider Business Mailing Address
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Address Line | 3800 S TAMIAMI TRL PARADISE PLAZA SUITE 305
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City | SARASOTA
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State | FL
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Zip | 34239-6908
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Country | US
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Telephone | 941-275-7966
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Fax | 941-429-7705
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MASAMI TANAKA KOLBENSCHLAG
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Credential | LMHC
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Telephone | 941-275-7966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9277
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License Number State | FL
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