Provider Demographics
NPI:1285092460
Name:BROWN, KELLIE (LMHC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 E MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-7370
Mailing Address - Country:US
Mailing Address - Phone:850-228-2466
Mailing Address - Fax:
Practice Address - Street 1:8820 E MAPLEWOOD ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-7370
Practice Address - Country:US
Practice Address - Phone:850-228-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health