Provider Demographics
NPI:1154497402
Name:SKEESICK, KELLY LEE (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:SKEESICK
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2136
Mailing Address - Country:US
Mailing Address - Phone:318-226-0411
Mailing Address - Fax:318-226-0462
Practice Address - Street 1:865 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2136
Practice Address - Country:US
Practice Address - Phone:318-226-0411
Practice Address - Fax:318-226-0462
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA862, 2978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional