Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2015002771 | MO |
Y | 101YP2500X | Professional Counselor | LPC.0013572 | CO |
N | 101YS0200X | School Counselor | MO |
NPI | 1003362476 |
---|---|
Provider Name | Kellie Hearndon |
First Address | Jacksonville, FL 32218-6058 |
Second Address | Aurora, CO 80014-1982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 09/06/2019 |