| NPI | 1407222078 |
|---|---|
| Former Name | KELLIE DOENGES TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701006242) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0701006242) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2023-11-15 |