Provider Demographics
NPI:1336547017
Name:BELL, KATHLEEN RUTH (MED, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:BELL
Suffix:
Gender:F
Credentials:MED, LMHC, NCC
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:BELL
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LMHC, NCC
Mailing Address - Street 1:10245 CENTURION PKWY N STE 250
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0561
Mailing Address - Country:US
Mailing Address - Phone:904-674-3521
Mailing Address - Fax:
Practice Address - Street 1:10245 CENTURION PKWY N STE 250
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0561
Practice Address - Country:US
Practice Address - Phone:904-674-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health