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General NPI Number Information
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NPI Number | 1669860607
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Entity Type | Individual
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Provider Name | KELLY GOMEZ LMHC
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Gender | Female
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 4900 W OAKLAND PARK BLVD FL 3
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-7500
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Country | US
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Telephone | 954-327-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 3804 NW 122ND TER
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City | SUNRISE
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State | FL
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Zip | 33323-3348
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Country | US
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Telephone | 786-253-2590
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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 | MH23169
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License Number State | FL
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