Doctor Name: | KRISTINE PANNING |
NPI Number: | 1053512848 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH 12033 |
Business Practice Address: | 1770 Cedar St Rockledge, FL - 329553133 |
Business Phone Number: | 3216377753 |
Business Fax Number: | |
Mailing Address: | 400 Sheridan Rd, MELBOURNE |
State: | FL |
Postal Code: | 329013122 |
Phone Number: | 3217225200 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2007 |
NPI Last Update Date: | 09/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 12033 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |