Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 168914 | KY |
NPI | 1003459066 |
---|---|
Provider Name | Melissa Pickett |
First Address | Shelbyville, KY 40065-7791 |
Second Address | Shelbyville, KY 40065-7791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 23/10/2019 |