Provider Demographics
NPI:1205445327
Name:KAM VIRTUAL THERAPEUTIC SERVICES INC
Entity type:Organization
Organization Name:KAM VIRTUAL THERAPEUTIC SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-720-2090
Mailing Address - Street 1:7643 GATE PKWY STE 104-941
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2893
Mailing Address - Country:US
Mailing Address - Phone:904-720-2090
Mailing Address - Fax:904-490-9998
Practice Address - Street 1:11266 LAKE MANDARIN CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7811
Practice Address - Country:US
Practice Address - Phone:904-705-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty