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General NPI Number Information
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NPI Number | 1144948183
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Entity Type | Individual
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Provider Name | KELLY WEAKLEY MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1403 CAT MAR RD
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City | NICEVILLE
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State | FL
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Zip | 32578-9742
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Country | US
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Telephone | 850-696-6640
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Fax | 850-807-5404
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Provider Business Mailing Address
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Address Line | 1403 CAT MAR RD
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City | NICEVILLE
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State | FL
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Zip | 32578-9742
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Country | US
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Telephone | 850-696-6640
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Fax | 850-807-5404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH21083
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License Number State | FL
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