MEDICARE: MRS. KELLIE-ANN PATRICE TORRES LMFT

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	101Y00000X	Counselor	MT4712	FL

General Provider Information

NPI Number	:	1558147132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLIE-ANN PATRICE TORRES LMFT

Provider Business Mailing Address
First Line	:	8359 BEACON BLVD STE 312
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3062
Country	:	US
Telephone Number	:	239-691-2520
Fax Number	:	239-986-8014

Provider Business Practice Location Address
First Line	:	8359 BEACON BLVD STE 312
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3062
Country	:	US
Telephone Number	:	239-691-2520
Fax Number	:	239-986-8014

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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