Individual
MS. BROOKE KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
3816 CALLIOPE AVE, PORT ORANGE, FL 32129-6024
(814) 442-8775
Mailing address
3816 CALLIOPE AVE, PORT ORANGE, FL 32129-6024
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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