Provider Demographics
NPI:1851376644
Name:DAVID, KELLY C (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:DAVID
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27718
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32411-7718
Mailing Address - Country:US
Mailing Address - Phone:850-913-8313
Mailing Address - Fax:850-249-7424
Practice Address - Street 1:7108 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-4984
Practice Address - Country:US
Practice Address - Phone:850-740-8082
Practice Address - Fax:850-303-0994
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH0003650103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26786OtherBCBS
FL593463899OtherTRICARE