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Provider Information for 1346967023


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Mrs. CRYSTAL ANN KELLY MS, LMFT


Other Names:  
Former Name: 
CRYSTAL ANN KELLY

Sex: Female

NPI: 1346967023
Last Updated: 2024-08-22
Certification Date: 2024-08-22

Details

NameValue
NPI1346967023
Enumeration Date2022-10-24
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 3466 SW PLUTO ST
PORT SAINT LUCIE, FL 34953-3483
United States

Phone: 954-465-0993 | Fax:
 
Primary Practice Address 1111 SE FEDERAL HWY STE 334
STUART, FL 34994-3839
United States

Phone: 239-690-6906 | Fax:
 
Secondary Practice Address(es)

3466 SW PLUTO ST
PORT ST LUCIE, FL 34953-3483
United States

Phone: 954-465-0993 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist FLMT4455