Healthcare Provider Details

I. General information

NPI: 1992519946
Provider Name (Legal Business Name): KELLY BECK, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAR WALT DR STE 2022S
FORT WALTON BEACH FL
32547-6960
US

IV. Provider business mailing address

907 MAR WALT DR STE 2022S
FORT WALTON BEACH FL
32547-6960
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-0095
  • Fax: 850-374-3192
Mailing address:
  • Phone: 850-243-0095
  • Fax: 850-374-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LYNN KELLY BECK
Title or Position: OWNER/DIRECTOR
Credential: MS, LMHC, CMHC, QS
Phone: 850-243-0095