Provider Demographics
NPI:1942718028
Name:ROKUS, KELLY JEAN (LPCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:ROKUS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:MOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 W 2ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3440
Mailing Address - Country:US
Mailing Address - Phone:507-312-9383
Mailing Address - Fax:507-229-1003
Practice Address - Street 1:50 W 2ND ST STE 103
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3440
Practice Address - Country:US
Practice Address - Phone:507-312-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01721101YP2500X
CC01721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional