1235481235 NPI number — NATHALY KALLIS MA, LMHC, CRC

Table of content: NATHALY KALLIS MA, LMHC, CRC (NPI 1235481235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235481235 NPI number — NATHALY KALLIS MA, LMHC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALLIS
Provider First Name:
NATHALY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINIELLO
Provider Other First Name:
NATHALY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235481235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 LAKE CARILLON DR
Provider Second Line Business Mailing Address:
SUITE 345
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33716-1129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-565-3077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 LAKE CARILLON DR
Provider Second Line Business Practice Location Address:
SUITE 345
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-565-3077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)