Healthcare Provider Details

I. General information

NPI: 1548696933
Provider Name (Legal Business Name): MS. LYNNE R KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 OCOEE APOPKA RD STE 106134
OCOEE FL
34761-5344
US

IV. Provider business mailing address

2222 OCOEE APOPKA RD STE 106134
OCOEE FL
34761-5344
US

V. Phone/Fax

Practice location:
  • Phone: 321-385-7681
  • Fax:
Mailing address:
  • Phone: 321-385-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11127
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20344
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004328A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: