Provider Demographics
NPI:1235526674
Name:KEMP, KELLY (M ED, LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:M ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0986
Mailing Address - Country:US
Mailing Address - Phone:407-690-3431
Mailing Address - Fax:
Practice Address - Street 1:222 W COMSTOCK AVE STE 112
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4272
Practice Address - Country:US
Practice Address - Phone:407-792-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health