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General NPI Number Information
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NPI Number | 1225163058
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Entity Type | Individual
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Provider Name | SUSAN DOROTHEA KELLEY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5201 W KENNEDY BLVD STE 615
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City | TAMPA
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State | FL
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Zip | 33609-1845
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Country | US
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Telephone | 813-974-0971
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 272749
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City | TAMPA
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State | FL
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Zip | 33688-2749
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Country | US
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Telephone | 813-969-3137
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Fax |
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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 | MH1135
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License Number State | FL
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