Provider Demographics
NPI:1447750450
Name:WENTZEL, KURT WILLIAM (LMHC)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:WILLIAM
Last Name:WENTZEL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W COTTESMORE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5604
Mailing Address - Country:US
Mailing Address - Phone:407-881-1379
Mailing Address - Fax:
Practice Address - Street 1:1540 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-245-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health