1. Home
  2. Directory
  3. Mississippi
  4. Jackson
  5. Counselor
  6. NPI Profile

KELLY BUCKHOLDT PH.D.
NPI 1083024079
Counselor in Jackson, MS

Active since April 30, 2014
1500 E WOODROW WILSON AVE, JACKSON, MS 39216(601) 364-7903 Get Directions Write a Review

NPPES record last updated: April 26, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 21, 2015, Dec 8, 2015 (2 updates tracked since 2015).

About Kelly Buckholdt Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY BUCKHOLDT PH.D. (NPI 1083024079) is an individual counselor in Jackson, Mississippi, licensed in Mississippi (54955) and active in the NPI registry since April 2014.

NPPES Registry Identity

NPI1083024079
Entity TypeIndividualFemale
Primary Taxonomy101Y00000X
Provider Legal NameKELLY BUCKHOLDTCredential: PH.D.
Location Address1500 E WOODROW WILSON AVEJackson, MS 39216-5116
Mailing Address1500 E Woodrow Wilson AveJackson, MS 39216-5116 · (601) 364-7903
Phone(601) 364-7903
Sole ProprietorYes
Enumeration DateApril 30, 2014
Last NPPES UpdateApril 26, 20162 updates tracked since enumeration
✔ NPI 1083024079 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License✔ Licensed in MS · 54955
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's degree and clinical experience and supervision for licensure or certification.
1500 E WOODROW WILSON AVE, Jackson, MS 39216
Open in Google Maps ↗

Other Identifiers 2

Medicare PIN461204YJ5DMS
Medicaid07971063MS

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELISSA ALLENE GRAIG RN
Registered Nurse
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 362-4471
DR. ELIZABETH NOSEN PH.D.
Psychologist
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 362-4471
WHITNEY ROWELL GERBER
Pharmacist
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 364-1352
MS. SANDRA TERRY-TURNER RPH
Pharmacist
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 362-4471
MR. GLENN D SHAW R.PH.
Pharmacist
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 364-1555
MRS. ANGELA A. CAUSEY MS, RD
Dietitian, Registered
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 362-4471
SONNY MONTGOMERY V A M EDICAL CENTER
Chronic Disease Hospital
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 362-4471
MRS. MOLLY WILLIS HOKE LCSW
Social Worker (Clinical)
1500 E WOODROW WILSON AVE
JACKSON, MS 39216
Hinds County (601) 352-4471

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Buckholdt's NPI number?

The NPI number for Kelly Buckholdt is 1083024079. It was assigned to this individual provider in the NPPES registry on April 30, 2014.

Where is Kelly Buckholdt located?

Kelly Buckholdt practices at 1500 E Woodrow Wilson Ave, Jackson, MS 39216. The listed phone number is (601) 364-7903.

What is Kelly Buckholdt's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Kelly Buckholdt was last updated on April 26, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.