Provider Demographics
NPI:1154521151
Name:MULROY, KELLY JOHN (LMHC)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JOHN
Last Name:MULROY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 LAND O'LAKES BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAND O'LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639
Mailing Address - Country:US
Mailing Address - Phone:813-765-2748
Mailing Address - Fax:
Practice Address - Street 1:3632 LAND O'LAKES BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAND O'LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639
Practice Address - Country:US
Practice Address - Phone:813-765-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health