Healthcare Provider Details

I. General information

NPI: 1588582571
Provider Name (Legal Business Name): KELLY TIMMINS RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W WINTER PARK ST
ORLANDO FL
32804-4901
US

IV. Provider business mailing address

15084 ANDREW ALY
WINTER GARDEN FL
34787-5643
US

V. Phone/Fax

Practice location:
  • Phone: 407-680-3388
  • Fax:
Mailing address:
  • Phone: 407-680-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number29391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: