Individual
KELLEY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 W JACKSON ST, B, BOLIVAR, MO 65613-1902
(417) 777-1458
Mailing address
4733 S ROBBERSON AVE, APT. 101 H, SPRINGFIELD, MO 65810-1786
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2005038988
MO
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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