| NPI | 1073700027 |
|---|---|
| Former Name | KELLIE LEIGH SHOCKNEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5796) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2011-11-22 |