Provider Demographics
NPI:1114700242
Name:WINKLER, KELLY KOHN (MAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KOHN
Last Name:WINKLER
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 BRICK CT STE 162
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9430
Mailing Address - Country:US
Mailing Address - Phone:407-529-9664
Mailing Address - Fax:
Practice Address - Street 1:5931 BRICK CT STE 162
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9430
Practice Address - Country:US
Practice Address - Phone:407-529-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health