Provider Demographics
NPI:1326764465
Name:KOTHUR, SRIKANT REDDY (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:SRIKANT
Middle Name:REDDY
Last Name:KOTHUR
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:SRI
Other - Middle Name:
Other - Last Name:KOTHUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:712 REID ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6444
Mailing Address - Country:US
Mailing Address - Phone:850-228-4725
Mailing Address - Fax:
Practice Address - Street 1:2634 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4106
Practice Address - Country:US
Practice Address - Phone:850-228-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health