MEDICARE: KELLY KEMP M. ED., LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH5038	FL

General Provider Information

NPI Number	:	1235526674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY KEMP M. ED., LMHC

Provider Business Mailing Address
First Line	:	PO BOX 986
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-0986
Country	:	US
Telephone Number	:	407-690-3431
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W COMSTOCK AVE STE 112
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4272
Country	:	US
Telephone Number	:	407-792-2969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	08/31/2015

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