Provider Demographics
NPI:1407072457
Name:KINZIE COUNSELING & CONSULTATION LLC
Entity type:Organization
Organization Name:KINZIE COUNSELING & CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:941-374-3846
Mailing Address - Street 1:6620 QUONSET RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9730
Mailing Address - Country:US
Mailing Address - Phone:941-374-3846
Mailing Address - Fax:941-751-4885
Practice Address - Street 1:73 S PALM AVE
Practice Address - Street 2:STE 215
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5638
Practice Address - Country:US
Practice Address - Phone:941-374-3846
Practice Address - Fax:941-751-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty