Provider Demographics
NPI:1952569139
Name:JEFFCOAT, KATHY ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:JEFFCOAT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:STOTT
Other - Last Name:JEFFCOAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:1135 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5321
Mailing Address - Country:US
Mailing Address - Phone:239-645-0409
Mailing Address - Fax:
Practice Address - Street 1:1135 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-5321
Practice Address - Country:US
Practice Address - Phone:239-645-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3645101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006645200Medicaid