Provider Demographics
NPI:1477937753
Name:KELLEY, MOIRA ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 BISHOP ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3052
Mailing Address - Country:US
Mailing Address - Phone:904-287-3073
Mailing Address - Fax:
Practice Address - Street 1:3135 BISHOP ESTATES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3052
Practice Address - Country:US
Practice Address - Phone:904-287-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health