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General NPI Number Information
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NPI Number | 1508102443
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Entity Type | Individual
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Provider Name | BRENDA KLEPACK
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Gender | Female
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 4701 N. MERIDIAN # 403522
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City | MIAMIA BEACH
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State | FL
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Zip | 33140
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Country | US
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Telephone | 786-277-6398
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 403522
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City | MIAMI BEACH
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State | FL
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Zip | 33140
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Country | US
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Telephone | 786-277-6398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH2530
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1386
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License Number State | FL
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