Provider Demographics
NPI:1114739315
Name:MARQUARD, KIM (LMHC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MARQUARD
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 1:508 LINDSEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-7234
Mailing Address - Country:US
Mailing Address - Phone:407-724-8970
Mailing Address - Fax:
Practice Address - Street 1:508 LINDSEY DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-7234
Practice Address - Country:US
Practice Address - Phone:407-724-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health