Doctor Name: | MRS. TRACY LEE KELSO |
NPI Number: | 1982960837 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH11185 |
Business Practice Address: | 16401 Gulf Blvd North Redington Beach, FL - 337081543 |
Business Phone Number: | 7273917001 |
Business Fax Number: | |
Mailing Address: | 16401 Gulf Blvd, NORTH REDINGTON BEACH |
State: | FL |
Postal Code: | 337081543 |
Phone Number: | 7273917001 |
Fax Number: | |
NPI Enumeration Date: | 04/04/2012 |
NPI Last Update Date: | 05/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH11185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |