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General NPI Number Information
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NPI Number | 1750112736
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Entity Type | Individual
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Provider Name | ANTHONY DAVID KELLEY D.MIN., LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 11310 CALLAWAY POND DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-2347
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Country | US
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Telephone | 656-208-8705
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 469 BOX 931
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City | APO
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State | AE
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Zip | 09227-1010
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Country | US
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Telephone | 859-577-0881
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 205458
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License Number State | TX
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