Individual
MR. JOHN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4550 LANTANA ROAD, SUITE A4, LAKE WORTH, FL 33463
(561) 340-7259
Mailing address
9170 SW 14TH ST APT 4107, BOCA RATON, FL 33428-6829
(561) 603-1807
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3217
FL
Other
Enumeration date
12/27/2011
Last updated
12/27/2011
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