Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1-04-1677 | FL |
NPI | 1093789828 |
---|---|
Provider Name | Ms. Kelly Lee Teeples |
First Address | Fort Lauderdale, FL 33312-4128 |
Second Address | Weston, FL 33326-3263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 12/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
689927796 | (05) | FL |
689927798 | (05) | FL |