Provider Demographics
NPI:1457581969
Name:MCCRACKEN, KELLY ROBIN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ROBIN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ROBIN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 WEKIVA SPRINGS RD. SUITE 300
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-754-5737
Mailing Address - Fax:407-788-7400
Practice Address - Street 1:195 WEKIVA SPRINGS RD. SUITE 300
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-754-5737
Practice Address - Fax:407-788-7400
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health