Provider Demographics
NPI:1508263609
Name:KELLY, ANITA MARIE (LMHC, CAP)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11254 58TH ST. N.
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2213
Mailing Address - Country:US
Mailing Address - Phone:727-545-6477
Mailing Address - Fax:727-545-6464
Practice Address - Street 1:11254 58TH ST. N.
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2213
Practice Address - Country:US
Practice Address - Phone:727-545-6477
Practice Address - Fax:727-545-6464
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12836101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH12836OtherLICENSE