Provider Demographics
NPI:1063784817
Name:DRIVER, KELLY S (MS, PMH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:DRIVER
Suffix:
Gender:F
Credentials:MS, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 MISSION BAY BLVD APT 218
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-5107
Mailing Address - Country:US
Mailing Address - Phone:205-566-3234
Mailing Address - Fax:
Practice Address - Street 1:8301 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3909
Practice Address - Country:US
Practice Address - Phone:407-249-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH1018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health