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General NPI Number Information
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NPI Number | 1821358011
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Entity Type | Individual
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Provider Name | STEPHEN ALLEN KUSHNER MA
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Gender | Male
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 1601 NE 25TH AVE SUITE 306
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City | OCALA
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State | FL
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Zip | 34470-8800
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Country | US
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Telephone | 352-231-0172
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Fax |
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Provider Business Mailing Address
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Address Line | 952 LIVE OAK LN
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-5000
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Country | US
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Telephone | 850-300-2565
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH20036
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License Number State | FL
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