MEDICARE: KELLY H FREUND 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	MH6111	FL

General Provider Information

NPI Number	:	1710917786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY H FREUND LMHC

Provider Business Mailing Address
First Line	:	1501 ROBERT J CONLAN BLVD NE
Second Line	:	SUITE 200
City	:	PALM BAY
State	:	FL
Zip	:	32905-3502
Country	:	US
Telephone Number	:	321-723-8823
Fax Number	:	321-723-9551

Provider Business Practice Location Address
First Line	:	1501 ROBERT J CONLAN BLVD NE
Second Line	:	SUITE 200
City	:	PALM BAY
State	:	FL
Zip	:	32905-3502
Country	:	US
Telephone Number	:	321-723-8823
Fax Number	:	321-723-9551

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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