Provider Demographics
NPI:1912244120
Name:SHELL, KERRY CORVEN (LMHC,EDS,MS,NCC)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:CORVEN
Last Name:SHELL
Suffix:
Gender:F
Credentials:LMHC,EDS,MS,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6463 BOLD VENTURE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1905
Mailing Address - Country:US
Mailing Address - Phone:850-509-5808
Mailing Address - Fax:
Practice Address - Street 1:3201 SHAMROCK ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3321
Practice Address - Country:US
Practice Address - Phone:850-509-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health