Healthcare Provider Details

I. General information

NPI: 1063869410
Provider Name (Legal Business Name): KELLIE FLONNOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 PAYNE AVE
CLEVELAND OH
44114-2919
US

IV. Provider business mailing address

6753 STATE RD
PARMA OH
44134-4517
US

V. Phone/Fax

Practice location:
  • Phone: 216-987-6849
  • Fax:
Mailing address:
  • Phone: 440-843-5544
  • Fax: 440-843-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606850
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: