Provider Demographics
NPI:1497513055
Name:KELLEY, KATHLEEN (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2638 HOMER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4216
Mailing Address - Country:US
Mailing Address - Phone:305-607-5504
Mailing Address - Fax:
Practice Address - Street 1:2638 HOMER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4216
Practice Address - Country:US
Practice Address - Phone:305-607-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health