Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 17754 | TX |
NPI | 1003052671 |
---|---|
Provider Name | Mrs. Kelly Lynn Rice |
First Address | Livingston, TX 77351-3465 |
Second Address | Livingston, TX 77351-3465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2009 |
Last Update Date | 01/01/2009 |