| NPI | 1760882682 |
|---|---|
| Former Name | STEPHANIE KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC017488) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2022-0059) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2024-08-27 |