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General NPI Number Information
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NPI Number | 1588042089
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Entity Type | Individual
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Provider Name | KAILEY ROSE MAHAN LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 5095 S WASHINGTON AVE STE 102
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City | TITUSVILLE
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State | FL
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Zip | 32780-7333
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Country | US
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Telephone | 407-917-6828
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Fax | 321-888-4922
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Provider Business Mailing Address
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Address Line | 4440 OSCEOLA RD
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City | TITUSVILLE
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State | FL
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Zip | 32780-6545
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Country | US
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Telephone | 321-482-7429
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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 | MH16362
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License Number State | FL
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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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