| NPI | 1194223156 |
|---|---|
| Former Name | JENNA LYNN KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2149) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12059A) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2020-07-22 |