Provider Demographics
NPI:1629320080
Name:KELLEY, DEBBIE L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:L
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:107 DR. MARTIN LUTHER KING JR. AVE, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450
Mailing Address - Country:US
Mailing Address - Phone:856-371-6602
Mailing Address - Fax:352-419-8783
Practice Address - Street 1:107 DR. MARTIN LUTHER KING JR. AVE, SUITE 2
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450
Practice Address - Country:US
Practice Address - Phone:856-371-6602
Practice Address - Fax:352-419-8783
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14195101YM0800X, 101YP2500X
NJ37PC00372900106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist