Provider Demographics
NPI:1518629856
Name:KELLY KREUTZ CONSULTING, LLC
Entity Type:Organization
Organization Name:KELLY KREUTZ CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-336-3100
Mailing Address - Street 1:7777 131ST ST STE 14
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-4015
Mailing Address - Country:US
Mailing Address - Phone:727-336-3100
Mailing Address - Fax:
Practice Address - Street 1:7777 131ST ST STE 14
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-4015
Practice Address - Country:US
Practice Address - Phone:727-336-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty