Provider Demographics
NPI:1043856909
Name:BRESKE, KRISTEN (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRESKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18495 S DIXIE HWY STE 318
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6817
Mailing Address - Country:US
Mailing Address - Phone:888-318-4788
Mailing Address - Fax:
Practice Address - Street 1:18495 S DIXIE HWY # 318
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6817
Practice Address - Country:US
Practice Address - Phone:888-318-4788
Practice Address - Fax:888-318-4788
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4989101Y00000X, 101YP2500X, 102L00000X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109969300Medicaid
FL1083971923OtherMENTAL HEALTH / BEHAVIORAL