MEDICARE: MRS. KRISTEN PENA OVERHOLT 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	101YM0800X	Mental Health Counselor	MH15821	FL

General Provider Information

NPI Number	:	1841849973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN PENA OVERHOLT LMHC

Provider Business Mailing Address
First Line	:	2600 S DOUGLAS RD STE 1003
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6142
Country	:	US
Telephone Number	:	305-445-0477
Fax Number	:	305-445-0958

Provider Business Practice Location Address
First Line	:	2600 S DOUGLAS RD STE 1003
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6142
Country	:	US
Telephone Number	:	305-445-0477
Fax Number	:	305-445-0958

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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