Provider Demographics
NPI:1912668344
Name:WILLS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GANDY BLVD N # 21113
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2409
Mailing Address - Country:US
Mailing Address - Phone:727-644-0353
Mailing Address - Fax:
Practice Address - Street 1:600 STARKEY RD APT 1516
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2867
Practice Address - Country:US
Practice Address - Phone:727-644-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor