Provider Demographics
NPI:1629493291
Name:VANCE, KAYLEE KATHRYN (LMFT; LMHC)
Entity Type:Individual
Prefix:MISS
First Name:KAYLEE
Middle Name:KATHRYN
Last Name:VANCE
Suffix:
Gender:F
Credentials:LMFT; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8135
Mailing Address - Country:US
Mailing Address - Phone:866-684-7743
Mailing Address - Fax:386-668-0542
Practice Address - Street 1:51 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-668-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2882106H00000X
FLMH12403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010864000Medicaid