Provider Demographics
NPI:1811398845
Name:BEDNARZ, KELLY (MS LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 QUIET COVE CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2665
Mailing Address - Country:US
Mailing Address - Phone:817-909-0432
Mailing Address - Fax:
Practice Address - Street 1:6425 PENSACOLA BLVD
Practice Address - Street 2:SUITE 1-3
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1701
Practice Address - Country:US
Practice Address - Phone:850-471-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist