Individual
KELCEE B PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1032 CROSSWINDS CT, WENTZVILLE, MO 63385-4836
(844) 853-8937
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
2021011818
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500075300
—
MO
Enumeration date
09/27/2019
Last updated
07/07/2023
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