Provider Demographics
NPI:1427530666
Name:HOWARD, KELLI (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CHURCHILL ST W STE 102
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6216
Mailing Address - Country:US
Mailing Address - Phone:651-323-1563
Mailing Address - Fax:
Practice Address - Street 1:209 CHURCHILL ST W STE 102
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6216
Practice Address - Country:US
Practice Address - Phone:651-323-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6270103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling