Provider Demographics
NPI:1326639592
Name:LAND, KATHIE L (LMHC)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:L
Last Name:LAND
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 1:382 NE 191ST ST
Mailing Address - Street 2:PMB 776953
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3899
Mailing Address - Country:US
Mailing Address - Phone:727-358-4840
Mailing Address - Fax:833-561-2501
Practice Address - Street 1:4693 SALISBURY RD RM 136
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6129
Practice Address - Country:US
Practice Address - Phone:727-358-4840
Practice Address - Fax:833-561-2501
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FLMH22625101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional