Provider Demographics
NPI:1689110629
Name:REDEL, KATY ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:ANN
Last Name:REDEL
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 1:2102 S RIDGEWOOD AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-4230
Mailing Address - Country:US
Mailing Address - Phone:864-028-3463
Mailing Address - Fax:
Practice Address - Street 1:2102 S RIDGEWOOD AVE STE 17
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-4230
Practice Address - Country:US
Practice Address - Phone:386-402-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH14686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932862513OtherGROUP NPI