Provider Demographics
NPI:1063156065
Name:KELCHNER, CASSONDRA LEE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:LEE
Last Name:KELCHNER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW CORPORATE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7337
Mailing Address - Country:US
Mailing Address - Phone:561-617-8751
Mailing Address - Fax:561-423-0711
Practice Address - Street 1:2201 NW CORPORATE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7337
Practice Address - Country:US
Practice Address - Phone:561-617-8751
Practice Address - Fax:561-423-0711
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health