Provider Demographics
NPI:1265835201
Name:GHENT, CATHY (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:GHENT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKE MIRIAM DR
Mailing Address - Street 2:SUITE W6
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2180
Mailing Address - Country:US
Mailing Address - Phone:863-370-8082
Mailing Address - Fax:
Practice Address - Street 1:202 LAKE MIRIAM DR
Practice Address - Street 2:SUITE W-6
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2180
Practice Address - Country:US
Practice Address - Phone:863-370-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100825251B00000X
FLMH16839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015826900Medicaid