| Doctor Name: | KELLY BUCKHOLDT |
| NPI Number: | 1083024079 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 54955 |
| Business Practice Address: | 1500 E Woodrow Wilson Ave Jackson, MS - 392165116 |
| Business Phone Number: | 6013647903 |
| Business Fax Number: | |
| Mailing Address: | 1500 E Woodrow Wilson Ave, JACKSON |
| State: | MS |
| Postal Code: | 392165116 |
| Phone Number: | 6013647903 |
| Fax Number: | |
| NPI Enumeration Date: | 04/30/2014 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 54955 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |