Individual
KELLI ELLEN LACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1148 E ELIZABETH ST, FORT COLLINS, CO 80524-4068
(970) 472-4133
(970) 493-6655
Mailing address
1148 E ELIZABETH ST, FORT COLLINS, CO 80524-4068
(970) 472-4133
(970) 493-6655
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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