Provider Information for 1346967023
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Mrs. CRYSTAL ANN KELLY MS, LMFT
Other Names:Former Name:CRYSTAL ANN KELLYSex: Female
NPI: 1346967023
Last Updated: 2024-08-22
Certification Date: 2024-08-22
Certification Date: 2024-08-22
Details
Name | Value | ||||||||
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NPI | 1346967023 | ||||||||
Enumeration Date | 2022-10-24 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
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 | ||||||||
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