Provider Demographics
NPI:1073700027
Name:HELDERMAN, KELLIE LEIGH (MA)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LEIGH
Last Name:HELDERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LEIGH
Other - Last Name:SHOCKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2022 KING CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2228
Mailing Address - Country:US
Mailing Address - Phone:719-332-5251
Mailing Address - Fax:
Practice Address - Street 1:179 PARKSIDE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-271-6306
Practice Address - Fax:719-572-6080
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO5796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health