Provider Demographics
NPI:1770633828
Name:KAUFHOLZ, BRIANNE G (MFTA)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:G
Last Name:KAUFHOLZ
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROWN OAKS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6166
Mailing Address - Country:US
Mailing Address - Phone:407-797-2326
Mailing Address - Fax:
Practice Address - Street 1:320 CROWN OAKS CENTRE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6149
Practice Address - Country:US
Practice Address - Phone:727-512-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05-0038106H00000X
WALF00002672106H00000X
FLMT2392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist