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General NPI Number Information
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NPI Number | 1801154877
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Entity Type | Organization
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Legal Business Name | WATERS & KAKLAMANOS, LLC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1664-2 METROPOLITAN CIRCLE
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5413
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Country | US
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Telephone | 850-385-1190
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Fax | 850-385-1191
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Provider Business Mailing Address
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Address Line | 1664-2 METROPOLITAN CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5413
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Country | US
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Telephone | 850-528-8895
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Fax | 850-385-1191
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST, MANAGER
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Name | DR. KEELY WATERS KAKLAMANOS
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Credential | PH.D.
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Telephone | 850-528-8895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4135
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7401
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License Number State | FL
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