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NPI Code Detail

MEDICARE: MRS. KELLY C DAVID LMHC

MEDICARE: MRS. KELLY C DAVID 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
1103T00000XPsychologistMH0003650FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126786OTHERFLBCBS
2593463899OTHERFLTRICARE

General Provider Information

NPI Number : 1851376644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY C DAVID LMHC
Provider Business Mailing Address
First Line : PO BOX 27718
Second Line :
City : PANAMA CITY
State : FL
Zip : 32411-7718
Country : US
Telephone Number : 850-913-8313
Fax Number : 850-249-7424
Provider Business Practice Location Address
First Line : 7108 QUAIL HOLLOW DR
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32408-4984
Country : US
Telephone Number : 850-740-8082
Fax Number : 850-303-0994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 06/27/2023

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Directions to “ MRS. KELLY C DAVID LMHC” Practice Location

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