Provider Demographics
NPI:1881879021
Name:KOLBENSCHLAG, MASAMI TANAKA (LMHC)
Entity type:Individual
Prefix:MS
First Name:MASAMI
Middle Name:TANAKA
Last Name:KOLBENSCHLAG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6908
Mailing Address - Country:US
Mailing Address - Phone:941-275-7966
Mailing Address - Fax:941-429-7705
Practice Address - Street 1:3800 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:PARADISE PLAZA SUITE 305
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6912
Practice Address - Country:US
Practice Address - Phone:941-275-7966
Practice Address - Fax:941-429-7705
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL454551121OtherTRI-CARE (HUMANA HEALTHCARE)
FLZ148MOtherBCBSF
FL60054OtherAETNA