License Number: MT2868

Data As Of 4/11/2021

Profession Licensed Marriage & Family Therapist
License MT2868
License Status CLEAR/ACTIVE
Qualifications Qualified Supervisor MHC Qualified Supervisor MFT
License Expiration Date 3/31/2023
License Original Issue Date 01/02/2014
Address of Record 3425 Bayside Lakes Blvd SE
Suite 103
PALM BAY, FL 32909
Discipline on File No
Public Complaint No

The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database.