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General NPI Number Information
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NPI Number | 1073753380
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Entity Type | Organization
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Legal Business Name | KELLY-JOHNSON COUNSELING, LLC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 3802 EHRLICH RD STE 304
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City | TAMPA
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State | FL
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Zip | 33624-2355
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Country | US
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Telephone | 813-765-9678
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 EHRLICH RD, SUITE 304
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City | TAMPA
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State | FL
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Zip | 33624
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Country | US
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Telephone | 813-765-9678
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. JULIET MARIE JOHNSON
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Credential | LCSW
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Telephone | 813-765-9678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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