Individual
MRS. KRISTA PUDERBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1465 LAKELAND DRIVE, JACKSON, MS 39216
(769) 777-1048
Mailing address
1465 LAKELAND DRIVE, JACKSON, MS 39216
(769) 777-1048
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
2196
MS
Other
Enumeration date
06/22/2015
Last updated
07/21/2022
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