Provider Demographics
NPI:1760732713
Name:GASH, KELLY-ANN ELIZABETH (RN, LMHC, MA)
Entity Type:Individual
Prefix:
First Name:KELLY-ANN
Middle Name:ELIZABETH
Last Name:GASH
Suffix:
Gender:F
Credentials:RN, LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15320 AMBERBEAM BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4629
Mailing Address - Country:US
Mailing Address - Phone:407-963-9820
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4200
Practice Address - Country:US
Practice Address - Phone:407-370-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11300101YM0800X
FLRN2038312163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management