Provider Demographics
NPI:1043546989
Name:KASTNER, COLLEEN J (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:J
Last Name:KASTNER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 SOUTH UNIVERSITY DRIVE
Mailing Address - Street 2:THE ATRIUM CENTER, SUITE 210
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-701-5955
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR
Practice Address - Street 2:THE ATRIUM CENTER, SUITE 210
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3839
Practice Address - Country:US
Practice Address - Phone:954-701-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11219101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor