Individual
KELLY LANE STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
13453 N MAIN ST STE 104, JACKSONVILLE, FL 32218-2773
(904) 773-4390
(941) 621-7089
Mailing address
13453 N MAIN ST, SUITE 104, JACKSONVILLE, FL 32218
(904) 773-4390
(941) 621-7089
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SG014
MEDICARE
FL
Enumeration date
01/17/2018
Last updated
03/29/2024
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