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General NPI Number Information
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NPI Number | 1750824090
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Entity Type | Organization
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Legal Business Name | KATHLEEN CAZENAVETTE
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 137 CRYSTAL BEACH DR STE 137-C
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City | DESTIN
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State | FL
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Zip | 32541
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Country | US
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Telephone | 850-226-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4507 FURLING LN STE 212
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City | DESTIN
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State | FL
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Zip | 32541-5343
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Country | US
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Telephone | 850-226-7100
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MARY KATHLEEN HENSLEY
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Credential | LMHC
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Telephone | 850-226-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH14574
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License Number State | FL
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