Individual
MS. KELLY MARIE GAUGHAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
102 WARREN ST, TUNKHANNOCK, PA 18657
(570) 836-1101
(570) 836-3765
Mailing address
33 EAST NORTHAMPTON STREET, WILKES BARRE, PA 18701-2492
(570) 822-7118
(570) 829-7781
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/13/2006
Last updated
07/08/2007
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