Individual
KELLY R HUISENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001912
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13975805
CAQH
MO
05
—
498106814
—
MO
Enumeration date
03/03/2017
Last updated
03/04/2019
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