Provider Demographics
NPI:1669640637
Name:AISSEN, KELLY A (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:AISSEN
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NW 33RD CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6459
Mailing Address - Country:US
Mailing Address - Phone:352-278-7008
Mailing Address - Fax:
Practice Address - Street 1:11 NW 33RD CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3260
Practice Address - Country:US
Practice Address - Phone:352-278-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health