Provider Demographics
NPI:1710610498
Name:THE KELLY BEHAVIORAL INSTITUTE LLC
Entity Type:Organization
Organization Name:THE KELLY BEHAVIORAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUMADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-893-0241
Mailing Address - Street 1:1060 WOODCOCK RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3502
Mailing Address - Country:US
Mailing Address - Phone:407-893-0242
Mailing Address - Fax:407-286-3840
Practice Address - Street 1:1060 WOODCOCK RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3502
Practice Address - Country:US
Practice Address - Phone:407-893-0242
Practice Address - Fax:407-286-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty