Individual
KELLY SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 NW 17TH AVE STE 272, DELRAY BEACH, FL 33445-2562
(305) 504-9236
Mailing address
1828 MY PL, WEST PALM BEACH, FL 33417-4571
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111703600
—
FL
Enumeration date
11/03/2021
Last updated
11/03/2021
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