| NPI | 1790847135 |
|---|---|
| Former Name | KELLY LEA SHEPARDSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 17541) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-11-20 |