Provider Demographics
NPI:1174258073
Name:KHADEMI, KATAYOUN
Entity Type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:KHADEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12819 BUTLER BAY CT
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6103
Mailing Address - Country:US
Mailing Address - Phone:305-319-3028
Mailing Address - Fax:
Practice Address - Street 1:12819 BUTLER BAY CT
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6103
Practice Address - Country:US
Practice Address - Phone:305-319-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health