Healthcare Provider Details

I. General information

NPI: 1760029466
Provider Name (Legal Business Name): KELLEY C FLYNN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 PLANTATION RD UNIT C
PENSACOLA FL
32504-4207
US

IV. Provider business mailing address

6704 PLANTATION RD UNIT C
PENSACOLA FL
32504-4207
US

V. Phone/Fax

Practice location:
  • Phone: 850-760-2300
  • Fax:
Mailing address:
  • Phone: 850-760-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: