Individual
KELLY D TUCKER BERNAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1103 WEBER RD, FARMINGTON, MO 63640-3345
(573) 664-1629
(573) 431-6580
Mailing address
PO BOX 844715, KANSAS CITY, MO 64184-4715
(417) 761-5214
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2001004272
MO
101YP2500X
Professional Counselor
Primary
2016042812
MO
Other
Enumeration date
12/16/2005
Last updated
03/27/2026
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