| NPI | 1740810654 |
|---|---|
| Former Name | KELLY STOCKEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 8203-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 4198-226) |
| Enumeration Date | 2020-01-20 |
| Last Update Date | 2023-11-07 |