Individual
KELLY J WILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
660 N 3RD AVE, TUCSON, AZ 85705-7856
(520) 329-3166
Mailing address
611 E 4TH ST, TUCSON, AZ 85705-7807
(570) 660-6325
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LAC-18119
AZ
101YP2500X
Professional Counselor
Primary
LPC-20247
AZ
Other
Enumeration date
04/28/2020
Last updated
11/08/2021
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