Individual
KELLEY B MOULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LMSW
Contact information
Practice address
911 ELLIS AVE, JACKSON, MS 39209-6256
(601) 533-7016
Mailing address
PO BOX 746085, ATLANTA, GA 30374-6085
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
9101
SC
1041C0700X
Clinical Social Worker
Primary
C9980
MS
Other
Enumeration date
10/20/2010
Last updated
11/13/2024
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