Provider Demographics
NPI:1306879416
Name:KATLER, CAROL JAYNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JAYNE
Last Name:KATLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:JAYNE
Other - Last Name:VEREBAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:2955 NW 126TH AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:954-937-7007
Mailing Address - Fax:
Practice Address - Street 1:940 E CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-937-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004317101YM0800X
FLMH4317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ062ROtherBLUE CROSS PROVIDER NUMBE