Provider Demographics
NPI:1184377251
Name:KELLMAN, TAVON
Entity type:Individual
Prefix:
First Name:TAVON
Middle Name:
Last Name:KELLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4820
Mailing Address - Country:US
Mailing Address - Phone:786-316-5314
Mailing Address - Fax:
Practice Address - Street 1:227 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-4820
Practice Address - Country:US
Practice Address - Phone:786-316-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health