Provider Demographics
NPI:1548859333
Name:PUCKETT, KELSEA (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELSEA
Middle Name:
Last Name:PUCKETT
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 1:686 S. SEGUIN AVE, UNIT 311996
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-2681
Mailing Address - Country:US
Mailing Address - Phone:830-515-8480
Mailing Address - Fax:817-585-4842
Practice Address - Street 1:1099 N. WALNUT, SUITE A
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-515-8480
Practice Address - Fax:817-505-4842
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80956101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional