MEDICARE: TAVON KELLMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184377251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVON KELLMAN

Provider Business Mailing Address
First Line	:	227 STRAWBERRY LN
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-4820
Country	:	US
Telephone Number	:	786-316-5314
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 STRAWBERRY LN
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-4820
Country	:	US
Telephone Number	:	786-316-5314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	01/30/2022

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Directions to “ TAVON KELLMAN ” Practice Location

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