| NPI | 1760617666 |
|---|---|
| Former Name | DEBRA KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071.007690) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 3-0874) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2016-04-25 |