| NPI | 1952682593 |
|---|---|
| Former Name | KELLY ANN CLEVENGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2011024383) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2011024383) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |