Provider Demographics
NPI:1801036397
Name:KINDRED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:KINDRED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-322-8018
Mailing Address - Street 1:3525 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3473
Mailing Address - Country:US
Mailing Address - Phone:407-322-8018
Mailing Address - Fax:407-322-8575
Practice Address - Street 1:3525 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3473
Practice Address - Country:US
Practice Address - Phone:407-322-8018
Practice Address - Fax:407-322-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8982101YM0800X
FLSW91371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty