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General NPI Number Information
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NPI Number | 1912244120
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Entity Type | Individual
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Provider Name | KERRY CORVEN SHELL LMHC,ED.S,M.S.,NCC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 3201 SHAMROCK ST S SUITE 103
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3321
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Country | US
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Telephone | 850-509-5808
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Fax |
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Provider Business Mailing Address
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Address Line | 6463 BOLD VENTURE TRL
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City | TALLAHASSEE
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State | FL
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Zip | 32309-1905
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Country | US
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Telephone | 850-509-5808
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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 | MH 11571
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License Number State | FL
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