Buckholdt, Kelly
Buckholdt, Kelly is an sole proprietor health care provider with primary practice located at 1500 E Woodrow Wilson Ave , Jackson MS 39216-5116. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Buckholdt, Kelly can be contacted via phone (601) 364-7903.Contact Information
Primary practice address
1500 E Woodrow Wilson Ave
Jackson MS 39216-5116
Phone: (601) 364-7903
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counselor | 101Y00000X | 54955 | Mississippi |
Profile Details
| NPI number | 1083024079 |
|---|---|
| LBN Legal business name | Buckholdt, Kelly |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 30th, 2014 |
| Last updated | Apr 26th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083024079 | NPPES |
| Mississippi | MEDICAID | 07971063 |
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