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Provider Information for 1497119556


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KELLY R JOHNSON LMHC


Sex: Female

NPI: 1497119556
Last Updated: 2016-04-05
Certification Date:

Details

NameValue
NPI1497119556
Enumeration Date2016-04-05
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 163333
ORLANDO, FL 32816-3333
United States

Phone: 407-823-2924 | Fax:407-823-4352
 
Primary Practice Address 4098 LIBRA DR
ORLANDO, FL 32816-3333
United States

Phone: 407-823-2924 | Fax:407-823-4352
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101Y00000X - Counselor FLMH 12142