=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790065043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATZ COUNSELING AND EDUCATIONAL PSYCHOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2011
-----------------------------------------------------
Last Update Date | 11/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12641 WORLD PLAZA LANE BLDG #56
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-3990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-247-1756
-----------------------------------------------------
Fax | 239-690-2438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12641 WORLD PLAZA LANE BLDG #56
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-3990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-247-1756
-----------------------------------------------------
Fax | 239-690-2438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. NOLAN HEYWOOD KATZ
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 239-247-1756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------