Provider Demographics
NPI:1609241694
Name:TATSCH, KELLY VALERIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:VALERIA
Last Name:TATSCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SQUIRREL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7380
Mailing Address - Country:US
Mailing Address - Phone:254-967-4705
Mailing Address - Fax:
Practice Address - Street 1:308 SQUIRREL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-7380
Practice Address - Country:US
Practice Address - Phone:254-967-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional