MEDICARE: CHERYL MARIELLE KANTZLER MS, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	MH9749	FL
2	101YM0800X	Mental Health Counselor	MH 9749	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487614582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL MARIELLE KANTZLER MS, LMHC

Provider Business Mailing Address
First Line	:	2100 CONSTITUTION BLVD STE 115
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4146
Country	:	US
Telephone Number	:	941-313-1878
Fax Number	:	941-244-5231

Provider Business Practice Location Address
First Line	:	2100 CONSTITUTION BLVD # 115
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4146
Country	:	US
Telephone Number	:	941-404-3781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	01/06/2020

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