Provider Demographics
NPI:1134429616
Name:KAUFMANN, HEATHER ELAINE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
Last Name:KAUFMANN
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 1:1815 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5979
Mailing Address - Country:US
Mailing Address - Phone:863-709-9392
Mailing Address - Fax:
Practice Address - Street 1:1815 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5979
Practice Address - Country:US
Practice Address - Phone:863-709-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health