Healthcare Provider Details

I. General information

NPI: 1144842527
Provider Name (Legal Business Name): DAVID, KELLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 QUAIL HOLLOW DR
PANAMA CITY BEACH FL
32408-4984
US

IV. Provider business mailing address

PO BOX 27718
PANAMA CITY FL
32411-7718
US

V. Phone/Fax

Practice location:
  • Phone: 850-740-8082
  • Fax: 850-303-0994
Mailing address:
  • Phone: 850-740-8082
  • Fax: 850-303-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY CARTWRIGHT DAVID
Title or Position: OWNER
Credential: LMHC
Phone: 850-740-8082