Healthcare Provider Details

I. General information

NPI: 1518005446
Provider Name (Legal Business Name): KELLY ANN KUGEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 HISTORIC RT 66 SUITE 201
WAYNESVILLE MO
65583
US

IV. Provider business mailing address

704 HISTORIC RT 66 SUITE 201
WAYNESVILLE MO
65583
US

V. Phone/Fax

Practice location:
  • Phone: 573-774-3121
  • Fax:
Mailing address:
  • Phone: 573-774-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18706
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2012003369
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10734
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: