Provider Demographics
NPI:1083381651
Name:BRENNEMAN, KAYLEE NICOLE (EDS, MED, LMHC)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:NICOLE
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:EDS, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S. FLORIDA AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801
Mailing Address - Country:US
Mailing Address - Phone:863-944-3237
Mailing Address - Fax:
Practice Address - Street 1:500 S. FLORIDA AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-274-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health