Provider Demographics
NPI:1881990729
Name:ALCOCK, KELLY KAY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:ALCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KAY
Other - Last Name:HELMBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:481 MERCERS FERNERY RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-1618
Mailing Address - Country:US
Mailing Address - Phone:904-708-5861
Mailing Address - Fax:
Practice Address - Street 1:481 MERCERS FERNERY RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-1618
Practice Address - Country:US
Practice Address - Phone:904-708-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst