Provider Demographics
NPI:1558257428
Name:HORN, KELLY MICHELLE (RMHCI)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:HORN
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BATH ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3510
Mailing Address - Country:US
Mailing Address - Phone:443-758-1056
Mailing Address - Fax:
Practice Address - Street 1:801 2ND ST N STE C
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3503
Practice Address - Country:US
Practice Address - Phone:727-210-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health