Provider Demographics
NPI:1710185012
Name:JOSEPH P SKELLY, P.A.
Entity Type:Organization
Organization Name:JOSEPH P SKELLY, P.A.
Other - Org Name:LORIEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:850-862-6030
Mailing Address - Street 1:151 MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-862-6030
Mailing Address - Fax:850-862-6030
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-862-6030
Practice Address - Fax:850-862-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty