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1083024079
KELLY BUCKHOLDT
JACKSON, MS
NPI
1083024079
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
(Licence: MS 54955)
Enumeration Date
2014-04-30
Last Update Date
2016-04-26
Business Address
-- KELLY BUCKHOLDT Ph.D.
1500 E WOODROW WILSON AVE
JACKSON, MS 39216-5116
Phone number: 601-364-7903
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Mailing Address
-- KELLY BUCKHOLDT Ph.D.
1500 E WOODROW WILSON AVE
JACKSON, MS 39216-5116
Phone number: 601-364-7903
Copy
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