MEDICARE: MS. LYNNE R KELLY

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	101YP2500X	Professional Counselor	11127	SC
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	MH20344	FL
4	101YM0800X	Mental Health Counselor	39004328A	IN

General Provider Information

NPI Number	:	1548696933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNNE R KELLY

Provider Business Mailing Address
First Line	:	2222 OCOEE APOPKA RD STE 106134
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-5344
Country	:	US
Telephone Number	:	321-385-7681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 OCOEE APOPKA RD STE 106134
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-5344
Country	:	US
Telephone Number	:	321-385-7681
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	03/03/2026

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