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NPI Code Detail

MEDICARE: MS. KELLY ELIZABETH ACKERSON LCPC, LAC

MEDICARE: MS. KELLY ELIZABETH ACKERSON LCPC, LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor1966KS

General Provider Information

NPI Number : 1013189703
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY ELIZABETH ACKERSON LCPC, LAC
Provider Business Mailing Address
First Line : 2514 MONTEZUMA CT
Second Line :
City : EMPORIA
State : KS
Zip : 66801-5865
Country : US
Telephone Number : 620-340-2735
Fax Number :
Provider Business Practice Location Address
First Line : 1103 COMMERCIAL ST STE D
Second Line :
City : EMPORIA
State : KS
Zip : 66801-2920
Country : US
Telephone Number : 620-412-8582
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2008
Last Update Date : 06/16/2021

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