Provider Demographics
NPI:1447627740
Name:KELLY, ANN 'ANITA' (MS, LMHC)
Entity type:Individual
Prefix:
First Name:ANN 'ANITA'
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 E CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5453
Mailing Address - Country:US
Mailing Address - Phone:407-896-8380
Mailing Address - Fax:
Practice Address - Street 1:1216 E CONCORD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5453
Practice Address - Country:US
Practice Address - Phone:407-896-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health