Provider Demographics
NPI:1184278236
Name:JEAN, KEMLEY (LMHC)
Entity type:Individual
Prefix:
First Name:KEMLEY
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 NW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4643
Mailing Address - Country:US
Mailing Address - Phone:786-370-5328
Mailing Address - Fax:
Practice Address - Street 1:1630 NW 176TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4643
Practice Address - Country:US
Practice Address - Phone:786-370-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health