Provider Demographics
NPI:1770959272
Name:MULDOON, KELSEY (LMHC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MULDOON
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 1:5850 HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6425
Mailing Address - Country:US
Mailing Address - Phone:954-283-3835
Mailing Address - Fax:954-722-4101
Practice Address - Street 1:5850 HIATUS RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6425
Practice Address - Country:US
Practice Address - Phone:954-283-3835
Practice Address - Fax:954-722-4101
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health