Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 15493 | CO |
NPI | 1003469511 |
---|---|
Provider Name | Kelly J Echols |
First Address | Woodland Park, CO 80866-0153 |
Second Address | Woodland Park, CO 80863-3196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 23/07/2019 |