Individual
MS. KELLEY GAYE WILBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3411 DIVISION DR, WEST PLAINS, MO 65775-5789
(417) 257-9152
(417) 257-9162
Mailing address
3411 DIVISION DR, WEST PLAINS, MO 65775-5789
(417) 257-9152
(417) 257-9162
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
494720303
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11545393
CAQH
MO
01
—
151551
BLUE CROSS BLUE SHIELD
MO
01
—
431116734
NEW DIRECTIONS
MO
05
—
494720303
—
MO
01
—
713333
HEALTHLINK PPO
MO
Enumeration date
09/06/2006
Last updated
07/08/2007
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