Provider Demographics
NPI:1144842527
Name:DAVID, KELLY
Entity type:Organization
Organization Name:DAVID, KELLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CARTWRIGHT
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-740-8082
Mailing Address - Street 1:PO BOX 27718
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32411-7718
Mailing Address - Country:US
Mailing Address - Phone:850-249-7400
Mailing Address - Fax:850-249-7424
Practice Address - Street 1:7108 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-4984
Practice Address - Country:US
Practice Address - Phone:850-740-8082
Practice Address - Fax:850-303-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)