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General NPI Number Information
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NPI Number | 1073301172
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Entity Type | Individual
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Provider Name | KELLY G STUCKEY
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 23010 GABRIEL
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City | NEW CANEY
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State | TX
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Zip | 77357-4163
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Country | US
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Telephone | 281-296-3158
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Fax |
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Provider Business Mailing Address
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Address Line | 22390 WHITE OAK DR
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City | CONROE
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State | TX
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Zip | 77306-8858
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Country | US
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Telephone | 281-536-3743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 79430
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License Number State | TX
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