Basic Information
| Provider Information | |||||||||
| NPI: | 1619609526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUDEVIZ | ||||||||
| FirstName: | ALANNA | ||||||||
| MiddleName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5214 46TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337093808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546218300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3840 5TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337137521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273672273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | IMH21841 | FL | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.