| NPI | 1316437205 |
|---|---|
| Former Name | KELLIE COOPER-SECREST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016322) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20043895) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2026-08-21 |