Provider Demographics
NPI:1164701686
Name:PEDERSEN, KERRI LYNN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LYNN
Last Name:PEDERSEN
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 1:13813 PATHFINDER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6451
Mailing Address - Country:US
Mailing Address - Phone:727-543-0142
Mailing Address - Fax:
Practice Address - Street 1:4000 GATEWAY CENTRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-6141
Practice Address - Country:US
Practice Address - Phone:727-543-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10178101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor