Provider Demographics
NPI:1386227544
Name:KOUTRAS, RENEE (LMHC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KOUTRAS
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 1:1528 ALBEMARLE CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2321
Mailing Address - Country:US
Mailing Address - Phone:727-900-4393
Mailing Address - Fax:
Practice Address - Street 1:3980 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3223
Practice Address - Country:US
Practice Address - Phone:727-487-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health