Provider Demographics
NPI:1922866540
Name:PUCKETT, KERRI WALKER (P-LPC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:WALKER
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 LAKELAND EAST DR STE C
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9025
Mailing Address - Country:US
Mailing Address - Phone:601-228-5840
Mailing Address - Fax:
Practice Address - Street 1:582 LAKELAND EAST DR STE C
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9025
Practice Address - Country:US
Practice Address - Phone:601-228-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional